Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Support and Assistance for Families
Family Support
Family support is defined here as the assistance given to
families to cope with the extra stresses that accompany caring for a child with
emotional disabilities. In addition to the stress of raising a child with an
emotional disability, families often face other difficulties such as poverty,
joblessness, substance abuse, and victimization. Family support often helps keep
families together by assisting them with the practicalities of living and by
attending to the needs of all family members (Will, 1998). The main goal of
family support services is to strengthen adults in their roles as parents,
nurturers, and providers (Weissbourd & Kagan, 1989). Too often, family support
services are not available within local communities.
Natural support systems are often diminished for families of children with
serious emotional, behavioral, or physical disorders or handicaps because of the
stigma of, or embarrassment about, their child’s problems, or because caregivers
have insufficient energy to reach out to others. Not surprisingly, most parents
report that limited social support decreases their quality of life (Crowley &
Kazdin, 1998) and that they feel less competent, more depressed, worried, and
tired and have more problems with spouses and other family relationships than
other parents (Farmer et al., 1997), although a few families do feel enriched by
caring for these children (Yatchmenoff et al., 1998).
In a national survey of parents of children with an emotional or behavioral
disorder, 72 percent of respondents indicated that emotional support
(irrespective of its form) was the most helpful aspect of family support
services (Friesen, 1990). Benefits included increased access to information,
improved problem-solving skills, and more positive views about parenting and
their children’s behavior (Friesen & Koroloff, 1990).
Family support services occur in several forms: assistance with daily tasks and
psychosocial support and counseling; informal or professional provision of
services; and practical support such as housing assistance, food stamps, income
support, or respite care (i.e., temporary relief for family members caring for
individuals with disabilities).
Efforts to stop blaming parents for children’s problems have resulted in parents
becoming viewed less as patients than as partners, actively involved in every
phase of the treatment process (e.g., home-based care, case management) and as a
resource for their children, as discussed above. For the self-help and
professionally led family support services described subsequently, parents may
function either as partners or as providers. As “partners,” parents act as a
resource, active contributor, or decisionmaker; as “providers,” they are viewed
as contributing to the welfare and growth of other members of the family.
Results of research on the effectiveness of family services are only beginning
to appear, in the form of some controlled studies and evaluations of support
services for families of children with emotional and behavioral disorders
(although there is a larger literature on families whose children have other
types of disability and illness). Although this database on family support
programs is still limited, many positive effects have been reported. The
following paragraphs cover family support groups as well as concrete services.
For the latter, only two types of interventions, respite care and the family
associate, are included. Family therapy is covered in this chapter under
Outpatient Treatment. Furthermore, several forms of parent training were found
to be effective for individual diagnoses, such as conduct disorder (see section
on Selected Mental Disorders in Children).
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