Working with family advocates is an emerging field and therefore there is limited research demonstrating the impact and effectiveness in improving outcomes for youth.
Colorado Integrated System of Care Family Advocacy Demonstration Program
In Colorado, in 2007, the Colorado General Assembly passed House Bill 07-1057, establishing the creation of family advocacy demonstration programs in three sites for youth with mental health or co-occurring disorders who are in or at risk of becoming involved with the juvenile justice system (see C.R.S. 26-22-101 to 106).
A final evaluation of the Colorado Integrated System of Care Family Advocacy Demonstration Program suggests that partnering with a family advocate can decrease the arrest rates of the youth involved in juvenile justice services. The Montrose County demonstration site, which is sponsored by the Montrose County School District RE-1J demonstrated an increase in school related outcomes in one year of services. Specifically, none of the juveniles in the program dropped out of school, and ten juveniles out of the 20 served had improved school grade performance. Twelve of the 20 juveniles served were identified as having significant school attendance issues or concerns. Ten of the 20 youth have shown considerable improvement in attendance, ranging from 12 to 147 percent. The evaluation report is included below.
PDF RESOURCE: Family Advocacy Demonstration Project Final Report
PDF RESOURCE: Focal Point Article on Family Advocacy by Bill Bane
For more information on the Family Advocacy Demonstration Program, contact Bill Bane, Colorado Department of Human Services, Division of Behavioral Health, Bill.Bane@state.co.us
Colorado Cornerstone System of Care Initiative
The Colorado Cornerstone System of Care Initiative began in 1999 through a grant to the Colorado Division of Mental Health from the Federal Center for Mental Health Services. Its goal was to build a system of care in four Colorado counties: Clear Creek, Denver, Gilpin, and Jefferson, for youth with serious emotional disturbance who were involved in or at-risk of involvement with juvenile justice system and their families.
The Cornerstone service delivery model focused on the dyad as the key element; the dyad was composed of a service coordinator and a family advocate. Outcome data for the Cornerstone project showed significant reductions in mental health symptoms and level of problems, although corresponding increases in the youths’ strengths were not found to be significant. Cornerstone youth improved in school functioning and some substance use measures, and family members reported significant reductions in overall caregiver strain. Further, family support was perceived to be one of the strongest aspects of the service approach.
Research on Family Support Programs
Family support services are directed at meeting the needs of parents or caregivers of children with mental health needs with the explicit purpose of helping parents/ caregivers (a) clarify their own needs or concerns; (b) reduce their sense of isolation, stress, or self-blame; (c) provide education or information; (d) teach skills; and (e) empower and activate them so that they can more effectively address the needs of their families.
A 2009 paper reviewing over 50 Family Support programs, reported that family-led programs were more likely to focus on caregiver satisfaction or caregiver perceived support. The primary focus of family-led programs tends to be more on targeting caregiver isolation and providing information and education. Outcomes in clinician-led models tended to focus on reduction in child’s symptoms, improvement in functioning, and parent mental health or stress reduction. Among clinician-led programs, the findings from the research clearly demonstrated the value of family support services.
In general, support services for parents produced superior child outcomes to standard treatment alone. This finding was consistent whether the program was an independent intervention, an augmentation to standardized child treatment, or an integrated component of child treatment. In addition to augmenting child outcomes, these studies found that parent support conferred important benefits for the parents, improving mental health and well-being, increasing self-efficacy, reducing stress, and improving perceived social supports and skills. It also improved family functioning, increased treatment engagement, and reduced barriers to care.
Family-to-Family Support Programs
The Parent Connections program, a parent-to-parent support organization developed by a team of parents and researchers to meet the needs of low-income families with high-risk youth, examined the effects of child functioning and the impact on maternal mental health and perceived support. In a randomized controlled clinical design trial the intervention produced modest positive effects. Further, it was found that building parents’ knowledge and skills can produce a heightened sense of efficacy, both at home and within the mental health and education systems.
Peer Led Interventions
The research tested the effectiveness of Family Associates serving as system guides, providing families with information, emotional support, and helping with specific barriers such as lack of transportation and lack of child care for other children. The intervention provided by the Family Associates was effective in helping families initiate mental health services. The findings suggest that outreach by the Family Associates may be effective in helping families get into services and on families’ sense of mastery and ability to cope with difficult situations.
Another report on this program concluded that 86% of families were very satisfied with their relationship with the Family Associate and 77% believed the Family Associate was very helpful with initiating mental health services for their children. Epstein, M.H., Kutash, K., & Duchnowski, A. (1998). Outcomes for children and youth with behavioral and emotional disorders and their families: Programs & evaluation best practices. Austin, TX, Pro-ed.
Research on Family Involvement
There is emerging research that family involvement has a positive impact on a youth’s outcomes. According to the Surgeon General’s Report on Mental Health:
Research is accumulating that family participation improves the process of delivering services and their outcomes. For example, Koren and coworkers (1997) found that, for children with serious mental health problems, the more the family participates in planning services, the better family members feel their children’s needs are being met; participation in service planning also helps service coordination. Curtis and Singh (1996) and Thompson and colleagues (1997) also found that family involvement in services was a determinant of the level of parental empowerment, that is, how much control parents felt they had over their children’s treatment.
Some of that research on family involvement includes:
Successful outcomes for youth involved in the juvenile justice and child welfare systems can be affected by the level of involvement the family has in their treatment and education. Family involvement is a crucial element in all stages of juvenile justice placement including diversion, probation, and out of home placement.
Family involvement is correlated with successful transition and reduced recidivism. See link below for more information.
PDF RESOURCE: NDTAC Issue Brief: Family Involvement
The research overwhelmingly demonstrates that parent involvement in children’s learning is positively related to achievement. Further, the research shows that the more intensively parents are involved in their children’s learning, the more beneficial are the achievement effects. This holds true for all types of parent involvement in children’s learning and for all types and ages of students. A review of the research demonstrates that the benefit for students include:
- Higher grade point averages and scores on standardized tests or rating scales,
- Enrollment in more challenging academic programs,
- More classes passed and credits earned,
- Better attendance,
- Improved behavior at home and at school, and
- Better social skills and adaptation to school.
Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness by imparting essential information concerning diagnoses, medication, treatment approaches, etc. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided ample training, technical assistance, and supervision to clinical staff; and have maintained a long-term perspective.
Research has assessed the impact that family partnerships have upon child and family outcomes. Research has demonstrated that family partnership may reduce the
length of stay in foster care, residential treatment, and psychiatric hospitals. Studies have shown parental visiting to be highly associated with shorter lengths of stay in foster care. Family participation in schools is associated with children’s enhanced academic performance and school competence. In addition, family partnership has been shown to improve the overall well being of the child. Family participation may change service provider’s approach to service delivery.
PDF RESOURCE: Family Participation in Systems of Care