The purpose of this study is to examine the dynamics between professional knowledge and the power to construct social realities. The focus is on the institutions which contributed to mental hygiene as a protocol for public policies directed toward children. The social history of the child in the twentieth century is juxtaposed with shifts in the configurations of private and public institutions in a sociology of mental illness. The mental hygiene movement created one of the twentieth century's major paradigms. Mental hygiene was conceptualized as the development of a science of promoting mental health and preventing mental illness. The' working premise of the movement was that early life experiences determined adult competence and constituted the root cause of major social problems from crime and dependency to labour unrest and war. The National Committee for Mental Hygiene was established in the United States in 1909 and a second National Committee was established in Canada in 1918. Mental hygienists developed an ideology of child oriented prevention in public health, welfare and educational policies which legitimated public intervention into the private spheres of family relations and child rearing. The idea of mental hygiene was based on a medical model and as such it was part of the new psychiatry and public health movements of the Progressive Era. As a paradigm mental hygiene fostered the identification of children according to scientific standards. Mental hygiene contributed to the transformation of juvenile delinquency into a psychiatry of maladjustment in childhood. As a positivistic approach to public health, mental hygiene research elaborated criteria to determine age related stages of normal psychological and biological progress. Mental hygiene was a product of professional researchers and policy makers. The knowledge base of mental hygiene grew with the expansion of higher education in the United States especially in regard to scientific medicine. The medical model was subsequently applied to research in the behavioural and social sciences. Scientific philanthropy provided funds for research, professional education, and the distribution of knowledge. The accumulation of monetary resources by nineteenth century entrepreneurial capitalists, who applied these funds to further the growth of scientific models, were a sustaining factor in twentieth century mental hygiene. The agents of power described as part of the mental hygiene movement include: 1) the National Committees for Mental Hygiene in the United States and Canada; and, 2) general purpose foundations in Rockefeller related philanthropy and the Commonwealth Fund. By mid-century, the federal, state/provincial and local governments of the United States and Canada had assumed major aspects of the former role of the National Committees and philanthropy in mental health advocacy. The theoretical foundation of mental hygiene evolved in conjunction with the development of the scientific method as applied to preventive medicine, especially in fields related to psychiatry. Mental hygiene was a primary carrier of the medical model into applied disciplines in the social and health sciences. The professionalization of education, social welfare and psychology, as imbued with mental hygiene, translated technological change into revised concepts of public and private spheres in relationship to family and child life. The medicalization of human differences limited the potential for radical revisions in social organization. It justified unequal access to political and economic power on the basis of psychological and biological characteristics. The mental hygiene paradigm served to maintain established social configurations in the face of social change. The function of justifying inequalities was especially important in the United States but less so in Canada for reasons of the timing of nation-building, national history, character, and culture. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

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It is generally reported that around one in 10 children in the UK today suffer from some kind of mental health problem. It is of course compulsory for all children between the ages of five and 16 to partake in a certain amount of education, which in the vast majority of cases means school. Head teachers are statutorily obliged to safeguard the children in their care, which also means addressing their physical and mental health. Therefore schools are growing in their importance as sites of mental health care interventions. There is little or no published research which explores the phenomenon of on site mental health provision from the perspective of the head teachers, in terms of how it impacts them. For this study, five head teachers of mixed sex primary schools were interviewed about the mental health service that they had commissioned for their school. All five participants employed the same service. Using the interpretive phenomenological approach to analyse these interviews, five major themes were discovered: ambivalence towards the mental health service; mixed feelings towards mental health issues; that the mental health service helped alleviate heads’ sense of anxiety; the paradoxical nature of head teachers’ intersubjective experience; and that while head teachers like to describe themselves as part of a collective identity, they locate themselves as individuals when they feel the need to assert power. It is hoped that these findings might aid providers of mental health services to schools and children by providing a more sophisticated understanding both of head teachers’, and therefore commissioners’, anxieties and positive feelings about such services.

This document is an invite to join me on a journey that follows the path of bereaved children, adolescents and their families who attended seven bereavement groups within a mental health setting. This thesis sets out to illustrate how families hold and maintain grief within the family system and how effective a bereavement group is as a form of therapeutic intervention. The bereavement group is a platform where families bring their private stories into a public domain and talk about the concerns that they have seen in their families since the bereavement. As an insider/outsider researcher I am of the opinion that by talking, listening and sharing their stories with other families with similar experiences within the groups, families can begin to think about what could be done differently if they want something to change within their family system. By sharing, families learn how to go with their grief without their loved ones and begin to create new narratives about the next part of their journey. The group can provide an opportunity for families to hear the ‘Untold’ stories and begin to create new narratives within their family system. The bereavement group also acts as a lens that allows me to look into my practice as a family therapist within a social constructionist framework and make new meaning of the stories that families bring within the bereavement groups. A tapestry is created from the complex diverse stories of grief that are interwoven with each family that attends the bereavement group. Each family brings their own pattern of bereavement and creates new patterns as their experience is shared with other families. Data is taken from the conversations at the assessment, treatment and follow up stages to highlight what difficulties the families have when there is bereavement. This is to ascertain what factors may be contributing to holding and maintaining the grief in the family and whether a bereavement group is effective in bringing the issues out for all family members to discuss. Different methods are used to deconstruct the different themes and unpick the ‘Told’ stories. At the end of this journey my hope is that there is more awareness about the effect of bereavement and how it shows itself in children’s mental health and how the family system can be affected.

In recent years there has been a dramatic increase in the number of children migrating to the United States without a parent. In Fiscal Year 2014 alone, U.S. immigration authorities apprehended and detained almost 70,000 unaccompanied children, compared to less than 9,000 in 2010. This rapid rise has been fueled primarily by children arriving from Central America, one of the world’s most violent regions. The available literature on unaccompanied children in the United States suggests that they are a vulnerable and underserved population, who are at risk for repeated exposure to extreme psychosocial adversities at every stage of their migration and frequently face many of these challenges alone. However, to date there has been little formal study of their mental health needs. The aim of this exploratory study was to obtain initial data regarding the psychosocial context, mental health presentation, and mental health service utilization of unaccompanied children released to guardians in the community pending immigration hearings to determine their eligibility to remain in the United States. The study employed a mixed methodology combining qualitative and quantitative data. The sample comprised 26 unaccompanied children and their guardians residing in the New York City metro area, interviewed between September 2013 and December 2014. Results showed that children in our sample had complex reasons for migration, frequently combining push factors such as fleeing gang violence and pull factors such as a desire for reunification with parents in the United States after long separations. Most had been exposed repeatedly to extreme psychosocial stressors prior to and during their migration, including almost two-thirds who had witnessed violence, serious injury, or death and over one-third who had witnessed domestic abuse or had been physically abused themselves. However, children also described benefitting from an array of supports that protected against stressors and promoted their wellbeing, and in their narratives they emphasized overcoming adversity rather than victimization. On a structured mental health diagnostic interview, the majority of children met criteria for one or more past-year anxiety and depressive disorders. Few received diagnoses for behavioral problems. Compared against these data, child-report measures screened more effectively for internalizing disorder diagnoses and guardian-report measures screened more effectively for externalizing disorder diagnoses. Despite the high rates of diagnosable disorders in the sample, most children appeared to be functioning well in family, social, and educational domains. No children were receiving formal mental health services at the time of their study interview, although several were being monitored by school counselors. Children presenting with mental health concerns were provided with referrals to mental health treatment services and contacted for a brief telephone follow-up interview three months later. At follow-up, a number of children had received counseling. Availability of school counselors and referral to therapists in the community through pediatricians were the primary facilitators of service access. Lack of knowledge of available, Spanish-speaking services and cost of treatment were common obstacles to seeking treatment. Some children and their guardians did not perceive a need for services, and most of these children appeared to be functioning well at follow-up. This study was designed to be largely descriptive and to provide data to inform future, theory-driven research. In the discussion section, social ecological models of risk and resilience and Hobfoll’s Conservation of Resources theory are presented as potential paradigms for understanding unaccompanied children’s migration processes, with stressors and supportive factors interacting across systemic levels and over time to determine children’s access to resources and their mental health, functioning, and wellbeing. Finally, the implications of the study’s findings for future research, psychosocial intervention, and rights-based advocacy with unaccompanied children are considered.

Objectives: The process of service intensity (SI) or level of care (LOC) determination regarding mental health services has a problematic history. There is a need for reliable and valid SI/LOC determination tools for youth in the child welfare system. Methods: In 2004 and 2005, the Tennessee Child Program Outcome Review Team (CPORT) reviewed 437 children and youth in the child welfare system (277 in state custody, 160 at risk of custody) of whom 61.6% were male, 64.8% Caucasian and 28.4% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators. Results: All CASII subscales significantly correlated to the CAFAS Total Scores (Pearson coefficients 0.225 to 0.454). The CASII Total Score and the CASII SI determinations were highly correlated to CBCL, YSR, and TRF total and sub-scales. Significant correlations between the CASII SI determinations were found across all of the 13 CPORT Child and Family Indicators, while actual placement significantly correlated with only three of the 13 dimensions. The actual SI/LOC placements were significantly divergent from the placement recommendations derived using the CASII instrument (p < 0.000) with the majority of CASII SI/LOCs recommendations being for less restrictive placements. Conclusions: The CASII SI/LOC tool demonstrates high levels of reliability and validity in multiple care contexts, including child welfare, juvenile justice, and mental health settings. Expanded use of the CASII could potentially result in less restrictive, more appropriate, and less costly services becoming available to youth in these systems.

All early childhood educators who work with children between birth and six years of age are likely to encounter young children who experience behavioral and mental health challenges throughout their careers. Research demonstrates that educators can play a vital role in children's mental health and behavioral development. However, often early childhood educators do not believe they have the knowledge or tools to accurately identify and successfully handle the unique challenges that arise when working with children with behavioral and mental health issues. Using an Anti-Oppressive Framework, this research study explores, through a qualitative case study design, how students in an in-service teacher education program experience children with mental health and behavioral issues in their classrooms. The following research question was used to guide this study: how do students in an in-service early childhood teacher education program think about, emotionally react to, and engage with children who express mental health issues and challenging behaviors in their classrooms? This paper begins by discussing the prevalence and needs of children with mental health and behavioral issues in early childhood environments. It then synthesizes the relevant literature related to the phenomenon. Next, it describes and defends a study that offered opportunities for students in an in-service teacher education program to consider their beliefs, emotions, and actions concerning inclusive education. From the research findings, implications for practice are revealed, offering ideas to support teacher education programs in better preparing their students to work with all young learners. Lastly, ideas for future research are elucidated.

The purpose of this study was to examine Latino cultural values of familismo and respeto and parenting to understand their relationship to child mental health among a community sample of Spanish-speaking Latino families primarily of Mexican origin. Literature suggests that familismo and respeto are unique and important Latino values, they have the most evidence to support their existence, and they are noted to be related to parenting and child outcomes. Research indicates that child behavioral problems can be improved by focusing on cultural values within the context of parenting. Very little attention, however, has been given to Latino cultural values among family processes. While the emergent literature has brought forth useful information, lack of consistency among findings and reliance on self-report methodology lead to many unanswered questions. To address this issue, we conducted a multi-method investigation involving a parent-child behavioral observation of parenting practices that were coded (i.e., warmth, supportive demandingness, nonsupportive demandingness, and autonomy granting) and parental self-report surveys of cultural values and child mental health. Participants included 87 families primarily of Mexican origin with a child between 4 and 9 years. Participants in the study were enrolled in phase 1 of a larger study to culturally adapt a parenting intervention. Overall, research demonstrated that cultural values impact parenting, and parenting impacts child mental health. Cultural values did not predict child mental health. Latino families reported high familismo and medium high levels of respeto and they were positively correlated. Latino families were observed to engage in high supportive demandingness, medium high levels of warmth and autonomy granting, and low levels of nonsupportive demandingness. For Latina mothers, nonsupportive demandingness and familismo demonstrated a statistically significant positive relationship. Results indicated that among Latina mothers autonomy granting evidenced a significant relationship with child externalizing behavioral problems. Implications for preventative methods and clinical interventions for Latino families as well as directions for future research endeavors are discussed.

This study examined the associations between social adversity, barriers-to-care (logistical obstacles, wait-time) and participation in children’s mental health treatment. The theoretical role of child symptoms (impact on the child, family burden) was addressed. Records were obtained for 1,963 parents who had accessed community-based care for their child (3-17 years). Data were collected as part of a provincial (Ontario, Canada) screening and outcome measurement initiative. The data were analyzed using multivariate logistic regression. Children with behavioural problems were at increased risk for attrition from treatment (OR=1.47, p < 0.001). The effect held upon controlling for age, gender, and co-morbid emotional symptoms; however, it was explained by child functional impairment. Similar effects were not found for the impact of symptoms on the family. Dropout was greater for adolescents (OR=1.43, p < 0.01) than younger children. Disadvantaged youth were more likely to drop out than more advantaged clients (OR=1.86, p < 0.001). Perceptions of difficulties in attending treatment were associated with a decreased risk (OR=0.89, p < 0.001). The adversity and service relationships were not mediated by child behavioural symptoms, functioning, or family burden. Waiting for care did not influence parent decisions to participate. Moderation analyses showed effects for adversity, service obstacles, emotional symptoms, functional impairment, and family burden for clients with behavioural problems. These children were more likely to drop out if they were socially disadvantaged, or had functional impairment at intake to services. However, completion was more likely for co-morbid children, and parental reports of burden. Families were also willing to overcome access difficulties in order to continue with treatment. There were few findings for children without behavioural problems. The results suggest a focus on other constructs, such as parent cognitions, that may link adversity and barriers with participation. The effects for symptoms as a moderator, suggests different levels of service provision based on sub-types of children. Efforts to engage “high-risk” clients are necessary. On the other hand, resources for intensive services would be appropriate for clients with more severe problems.

This study examined the associations between social adversity, barriers-to-care (logistical obstacles, wait-time) and participation in children’s mental health treatment. The theoretical role of child symptoms (impact on the child, family burden) was addressed. Records were obtained for 1,963 parents who had accessed community-based care for their child (3-17 years). Data were collected as part of a provincial (Ontario, Canada) screening and outcome measurement initiative. The data were analyzed using multivariate logistic regression. Children with behavioural problems were at increased risk for attrition from treatment (OR=1.47, p < 0.001). The effect held upon controlling for age, gender, and co-morbid emotional symptoms; however, it was explained by child functional impairment. Similar effects were not found for the impact of symptoms on the family. Dropout was greater for adolescents (OR=1.43, p < 0.01) than younger children. Disadvantaged youth were more likely to drop out than more advantaged clients (OR=1.86, p < 0.001). Perceptions of difficulties in attending treatment were associated with a decreased risk (OR=0.89, p < 0.001). The adversity and service relationships were not mediated by child behavioural symptoms, functioning, or family burden. Waiting for care did not influence parent decisions to participate. Moderation analyses showed effects for adversity, service obstacles, emotional symptoms, functional impairment, and family burden for clients with behavioural problems. These children were more likely to drop out if they were socially disadvantaged, or had functional impairment at intake to services. However, completion was more likely for co-morbid children, and parental reports of burden. Families were also willing to overcome access difficulties in order to continue with treatment. There were few findings for children without behavioural problems. The results suggest a focus on other constructs, such as parent cognitions, that may link adversity and barriers with participation. The effects for symptoms as a moderator, suggests different levels of service provision based on sub-types of children. Efforts to engage “high-risk” clients are necessary. On the other hand, resources for intensive services would be appropriate for clients with more severe problems.