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Strengthening social support: Research implications for interventions in children's mental health

January 2006

Authors:

Melanie Sage

University at Buffalo, The State University of New York

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FOCAL POiNT

Winter 2006

Rese

arch, P

olic y,

and P

rac tic

e in

Chil

dren’s M

ntal H

ealth

Strengthening Social Support

FOCAL POiNT

FOCAL POiNT Vol. 20, No. 1

Winter 2006

Strengthening Social Support

Janet S. Walker &

Melanie Sage............................3

My Greatest Ally

Craig Delano.............................8

Building Family-to-Family Suppor t

Programs: Rationale, Goals, and

Challenges

Henry T. Ireys & Diane

Dvoskin Sakwa........................10

Unmasking Lena

Lena Gladden..........................12

The “Keys for Networking”: Targeted

Parent A ssistance

Jane Adams, Elizabeth

Westmoreland, Corrie Edwards

& Sarah Adams........................15

Techniques for Assessing Social

Suppor t

Mary I. Armstrong...................19

Social Support from Adults and Peers in

Early Adolescence:

It’s a Balancing Act

Naida Silver thorn &

David L. DuB ois.......................23

Wraparound and Natural Supports:

Common Pr actice Challenges and

Promising Coaching Solutions

Greg S. Dalder.........................26

Natural Supports from a Parent

Perspective

Greg S. Dalder & Lyn Gordon

(from an interview with Jeanette

Barnes)...................................29

FOCAL POiNT is a publication of the Re-

search and Training Center on Family

Support and Children’s Mental Health.

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Disability and Rehabilitation Research,

United States Department of Educa-

tion, and the Center for Mental Health

Services, Substance Abuse and Mental

Health Services Administration (NIDRR

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ﬂect the views of the funding agencies.

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Nicole Aue, aue@pdx.edu, Assistant Editor

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large body of research evidence Hogan, Linden, & Najarian, 2002). ment. Yet, as is the case with research

demonstrates that people who The lack of knowledge about on social support interventions more

are involved in supportive social rela- whether and how social support in- generally, evaluations of these models

tionships experience benefits in terms terventions work is an important issue of community-based care have not

of their health, morale, and coping. within children’s mental health. There so far demonstrated success from ef-

Conversely, low levels of social sup- is a growing consensus in the field that forts to increase social support (Cox,

port have been repeatedly linked to strengthening interpersonal and com- 2005).

poor physical and mental health out- munity ties is a promising resilience- When thinking about the implica-

comes. Recognition of the benefits of and development-promoting strategy tions of this research, it is obviously

social support has fueled the develop- for all children and families who are important to maintain a sense of re-

ment of a wide variety of interven- affected by mental health difficulties. alism and to acknowledge that the

tions designed to improve the quantity For children and youth with the high- field does not at this point have a wide

or quality of the support that people est levels of need, the field is increas- repertoire of proven and potent strat-

receive. Unfortunately, evaluation of ingly embracing the idea of commu- egies for strengthening social support

these interventions has so far not yield- nity-based care as an alternative to for children and youth with mental

ed clear information about what sorts out-of-home placements. A common health difficulties and their families.

of intervention are most likely to be element of models for community- What we do have are a few strategies

successful. Indeed, it is not even clear based care—including wraparound, that appear promising and a few that

that social support interventions—as multisystemic therapy, and intensive have been modestly successful. Most

they are currently implemented—are family preservation services, among of these strategies focus on providing

actually successful at increasing social others—is the emphasis on strength- support to caregivers. With the excep-

support for people who lack it (Co- ening family ties to supportive people tion of mentoring programs, strategies

hen, Underwood, & Gottlieb, 2000; within the family’s social environ- for increasing social support for ado-

STRENGTHENING SOCIAL SUPPORT:

FFOOCCAALL PPOOiiNNTTis produced bis produced by the Ry the Research and Tesearch and Trraining Center on Faining Center on Family Support amily Support

and Children’and Children’s Mental Health in Ps Mental Health in Portland, Oregon.ortland, Oregon.

RESEARCH IMPLICATIONS FOR INTERVENTIONS IN

CHILDREN’S MENTAL HEALTH

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

FOCAL POiNT 3

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

lescents or children have not been well

studied. On the other hand, this does

not mean that other strategies that are

currently in use have been disproven,

nor does it mean that we cannot build

on what we are learning in order to

improve existing strategies and create

new ones.

This issue of Focal Point explores

some of what we do and don’t know

about strengthening social support.

This introduction outlines some of

the major concepts and themes in re-

search on social support, and some

implications of this research for inter-

ventions in children’s mental health.

This sets the stage for the rest of the

issue, which presents information and

examples that can be

helpful in future efforts

to design and imple-

ment social support

strategies and interven-

tions for children and

families.

Types of Support

The literature offers

many definitions of so-

cial support; however,

most definitions refer

to the exchange of one

or more of three main

types of support—

emotional, informa-

tional, and instrumental—that people

provide to friends and family mem-

bers in times of need. Emotional sup-

port involves the expression of empa-

thy, reassurance, and positive regard,

and is believed to enhance well-being

by promoting self-esteem, reducing

distress, and providing an emotional

context for positive coping efforts. In-

formational support involves the provi-

sion of guidance, advice, or other in-

formation that can reduce confusion,

increase perceptions of self-efficacy,

and form the basis for positive coping

strategies. Instrumental support refers

to the provision of money, goods, and

services that can be used in coping

and problem solving efforts.

Additionally, some theories of so-

cial support also highlight the impor-

tance of social integration—a sense of

belonging—and the role of compan-

ionship—participation in social and

leisure activities. Many social support

interventions are aimed at fostering

peer support—emotional support from

people who share key experiences

with the recipient. In the case of chil-

dren’s mental health, peer support to

caregivers is seen as helping to reduce

feelings of social isolation and reduce

feelings of shame and self-blame.

Families can access social support

through both natural and more formal

support systems. Natural support, also

often called informal support, is most

typically provided in relationships

with friends and family, while formal

support is provided by professionals.

Many sources of support, however, do

not fall neatly within one or the other

category; support offered through

community or peer-run organizations,

for example, may mix the two. Within

children’s mental health, a key distinc-

tion is whether or not the support is

from sources that are likely to endure

in the family’s life. It is thought that

families who receive consistent sup-

port from these enduring sources will

not only achieve higher levels of com-

munity integration and well-being, but

will also become less entangled with

(and dependent upon) formal servic-

es. Efforts to intervene thus typically

focus on strengthening a family’s con-

nections to natural support systems

and to community organizations such

as clubs, religious organizations, and

peer-run support organizations.

Lessons from Research

The research on social support

interventions comes from many dif-

ferent fields and encompasses many

different intervention strategies. Con-

sequently, results may or may not be

relevant for interventions in the field

of children’s mental health. What is

more, methodological, analytical, and

conceptual difficulties make it diffi-

cult to draw firm conclusions from the

existing literature. In reviewing exist-

ing research, it is thus important to

avoid jumping to premature conclu-

sions: There is much

we don’t know at this

point about the specif-

ics of whether and how

social support interven-

tions “work.” Despite

these shortcomings, the

literature does point to

some particular chal-

lenges that should be

acknowledged—and

some promising strate-

gies that can be incor-

porated—in the design,

implementation, and

evaluation of future

social support inter-

ventions in children’s

mental health.

In the field of children’s mental

health, efforts to increase social sup-

port for caregivers typically use one of

two basic types of interventions: those

that aim to mobilize peer support and

those that strive to increase support

available from naturally occurring so-

cial networks.

Peer Support

As is true with the research on so-

cial support intervention more gen-

erally, conclusions from research on

peer support can only be tentatively

drawn; however, in general, it appears

that providing support through peers

is a promising approach. Peer-to-peer

support interventions generally fall

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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into two basic types: peer support

groups, and peer support at the indi-

vidual level.

In peer support groups, participants

can both offer and receive aid, usually

emotional support, but sometimes

also informational and instrumental

support. In addition, peer support

groups offer an opportunity for mem-

bers to add new relationships to their

social networks. Despite the popu-

larity of such groups, there are rela-

tively few studies that evaluate their

outcomes. While some of these stud-

ies show benefits from participation,

others do not (Hogan et al., 2002).

Research has typically documented

participants’ satisfaction with groups

(Helgeson & Gottlieb, 2000), but a

small number of studies have shown

other benefits, including improved

social support and general well-being.

There may be many reasons for these

inconsistent findings, but research-

ers caution that in loosely structured

support groups, the quality of support

may be quite variable. Group mem-

bers may interact in ways that actually

increase stress, undermine self-confi-

dence, and promote the use of ineffec-

tive problem solving strategies. Thus,

structured groups that are led by well-

trained facilitators, and that offer an

educational or informational compo-

nent may be most helpful (Helgeson

& Gottlieb, 2000).

Individual-level peer-support

interventions typically pair pro-

gram participants with support

providers who share salient ex-

periences or conditions. Such

interventions usually aim to

increase emotional support, but

also often include an explicit

focus on informational support;

they may also target instrumen-

tal support by teaching advo-

cacy skills and/or by having the peer

interveners help participants access

community resources. Hogan (2002)

finds the research on these types of

interventions “encouraging,” particu-

larly when peer supporters are trained

to interact with program participants

in ways that maximize emotional sup-

portiveness and offer problem solving

strategies and information. However,

since the number of research studies

is small, and since the interventions

differ substantially one from another,

existing research does not provide

firm guidance about which interven-

tion components or strategies might

be most effective, or under what cir-

cumstances.

The articles on Parent Connections

(pages 10-14 in this issue) and Keys

for Networking (pages 15-18) describe

peer support programs that are consis-

tent with main themes from existing

research. Both rely on well-trained

peers who provide a combination of

emotional and informational support.

Peer supporters in both programs

also model and teach advocacy skills,

which are a route to increasing the in-

strumental support available to fami-

lies. Importantly, both programs also

offer opportunities for participants

to give and receive support. Newer

commentaries on social support inter-

vention often highlight the idea that

support is most beneficial when the

support relationships are reciprocal.

Offering support increases feelings

of self-efficacy and competence, and

builds a sense of belonging to and be-

ing valued by a social group. It is pos-

sible that this is particularly important

for people at times when self-worth is

challenged by stressful events and stig-

ma. Finally, both programs also have

the backing of a larger peer-run orga-

nization, though this is more central

to the intervention in the Keys model.

Connecting caregivers with the larger

organization provides access to a va-

riety of different people, activities,

and groups, and a wide variety of po-

tentially supportive relationships. An

organization also has the potential

to provide a stable source of support

over time. This can help guard against

‘burning out’ individual support giv-

ers, or over-reliance on a particular

relationship, since support can come

from multiple sources. This may be

particularly important when support

is being provided by caregivers who

may experience periodic crises arising

from their own children’s difficulties.

Having access to a variety of support-

ive relationships and activities is also

in line with recent interpretations of

research that suggest that support will

be more effective when it is matched

with recipients’ needs (Gottlieb,

2000). A larger organization offers

choices so that people can access the

kinds of support that they find most

comfortable and helpful.

Intervening in Natural Networks

The most compelling rationale for

intervening to increase support in nat-

ural networks is that there is a long-

term commitment from friends and

family members that is not typically

available from paid relationships. The

support of friends and family is par-

ticularly predictive of positive health

and mental health outcomes (Cutrona

& Cole, 2000; Werner, 1995). What

is more, support offered through the

natural network is more likely to be

culturally appropriate, and may be

easier to accept than professional

help. Natural network interventions

vary along a number of dimensions,

and the number of research studies is

small; however, once again, research

indicates that this approach can be

beneficial (Cutrona & Cole, 2000; Ho-

It is thought that families who receive consistent

support from enduring sources will not only

achieve higher levels of community integration

and well-being, but will also become less entangled

with (and dependent upon) formal services.

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

This article and others can be found at www.rtc.pdx.edu. For reprints or permission to

reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

gan et al., 2002).

The most-researched approach to

intervening in natural networks in-

volves the use of interventions that are

intended to improve the quality of re-

lationships within an existing network.

These interventions are motivated by

some studies showing that “negative

support” (behavior that is perceived

as harmful, critical, or hostile, or

that contributes to stress

or anxiety) has a stron-

ger link to outcomes than

positive support (Hogan

et al., 2002). Even among

well-intentioned friends

and family, interactions

intended to be supportive

may have the opposite ef-

fect. This can happen, for

example, when supporters

minimize a problem by

implying that it is not seri-

ous, or when sympathetic

supporters go too far in

the other direction by cat-

astrophizing the problem.

Interventions thus focus

on working to improve in-

teractions within the sup-

port network by teaching a variety of

relationship skills, including problem

solving, communication skills, and/or

assertiveness. One type of approach

focuses on teaching friends and fam-

ily how to improve the quality of the

support they provide to people who

experience chronic stress. This kind of

approach is one of the components of

family psychoeducation, a set of evi-

dence-based practices used with adult

mental health consumers and their

families (McFarlane, 2003). Other in-

terventions have focused on teaching

relationship skills to people in need of

support, and the results of these stud-

ies have been encouraging (Hogan et

al., 2002). The best-evaluated interven-

tions to improve relationship skills are

those that have been created and led

by professionals, and the distinction

between this kind of intervention and

various forms of psychotherapy is not

always clear. On the other hand, this

distinction may not be as important

as other dimensions of the interven-

tion, such as whether it is delivered in

a strengths-based or recovery-oriented

manner. What is more, the same types

of intervention can also be designed

and delivered by peers. For example,

family advocacy organizations have

offered peer-led programs that include

many of the same components as pro-

fessionally-led family psychoeduca-

tion programs.

The articles on wraparound (pages

26-30) describe other strategies for in-

tervening in natural networks: engag-

ing network members in providing

specific forms of support, coordinat-

ing support available from an existing

network, and recruiting new members

into the network. These strategies

have intuitive appeal, and they are a

core component of several varieties of

person-centered planning. A number

of studies of these kinds of interven-

tions have been published, and posi-

tive outcomes have been documented;

however, the evaluation strategies

used were often weak. Thus these

studies offer only limited insight into

whether or when these strategies are

helpful in producing long term in-

creases in social support or other de-

sired outcomes. Given the increasing

popularity of wraparound and allied

interventions within children’s mental

health, it is clearly important to build

knowledge in this area. Continued on pg. 8:

Strengthening Support

Interventions for Youth

For younger children, the family is

the most important source of support,

and many therapeutic interventions

have been developed to increase the

supportiveness of family relationships.

However, these are not usually consid-

ered social support interventions per

se. Throughout later childhood and

adolescence, young peo-

ple develop wider social

networks that include

peers and others from

the community. The re-

search described in the

article by Silverthorn

and DuBois (page 23-

25) supports the hypoth-

esis that good outcomes

for youth are promoted

when young people re-

ceive social support that

is balanced between peer

and adult sources. The

article also describes

GirlPOWER!, a mentor-

ing program designed to

increase available social

support. Mentoring is

perhaps the best studied social support

intervention for youth, and research

has provided guidelines for develop-

ing effective programs (Herrera, Sipe,

& McClanahan, 2000). In essence,

mentoring programs like GirlPOW-

ER! are designed to add new, compe-

tent adults to a young person’s social

network. Mentors are trained to offer

emotional support, and often, as is

the case with GirlPOWER!, programs

also include informational support

that focuses in part on how to build

healthy—supportive—relationships

with peers and to recruit additional

support from adult sources. This type

of intervention combines many of

the components of interventions for

adults described above, and often oc-

curs in the context of a community or

youth-serving organization that offers

youth multiple routes to access social

support through participation in a va-

riety of activities and relationships.

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

This article and others can be found at www.rtc.pdx.edu. For reprints or permission to

reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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After arriving home from a hard

day’s work, I slip off my jacket and

boots. I look out the kitchen window

to glance a peek at the snow-covered

ground on a beautiful December day.

The lawn is all dressed in white. As

I look across the street at a cozy yel-

low ranch home, I notice the evening

sun reflecting off the

icicles growing from

the roof ’s drip cap.

Suddenly, my eyes

begin to fill with glee

and my heart fills

with joy as I remi-

nisce fond winter

childhood memories

of a small city off

the shores of Lake

Michigan where my

family used to live.

In those days,

the snow was my

dreamland. My two

sisters and I would

eagerly come home

from school to hot

chocolate and a tasty

snack mom would prepare for us al-

most daily. A little snack was essen-

tial after walking five blocks in snowy

conditions, or at least that was what

we led mom to believe. After happily

consuming our treats, completing our

homework, and viewing some tele-

vision, we would venture outdoors.

Since we lived on a city block, the only

hill available to slide on was the snow

hill in the front yard that dad created

from the snow he shoveled from the

driveway. We would slide down our

snow hill until our boots were soaked

and our little fingers were numb. Then

we would return indoors where mom

kept warm as she prepared our deli-

cious hot meals. After our meals and

kitchen duties, it would be bedtime.

Bedtime was also an anticipated time,

as mom and dad together would snug-

ly cover my sisters and me in our beds.

Throughout the night I would dream

of how exciting the next day would

also be. But, like the night, the dream

did not last much longer.

When I was 9, my father left us.

Consequently, things were never the

same, My hero, the one I most ad-

mired, abandoned us for a new life.

What he did not realize was that the

lives of my mother, my sisters, and

me were taken away because we were

no longer good enough. For the first

time in my life I felt horrific pain, like

a stab to the heart. This is much more

difficult to heal than average pain.

The anguish would grow for years

to come. At this point, my behavior

started to change. It began at school.

I would leave my class briefly to visit

the restroom and then scurry to the

main office where I would claim to be

ill, adamantly requesting to go home.

This was routine for several months.

Later, my conduct developed into act-

ing out in class and skipping school.

These actions were unlike me. Teach-

ers were beginning to become con-

cerned with my transformed behavior.

My mother soon arranged therapy for

me at Catholic Social Services. None-

theless, I refused to comply with the

several therapists who had seen me.

Meanwhile, my negative actions con-

tinued as time progressed.

When I was 11, my mom, my sis-

ters and I moved 55 miles away to a

small town. Here

would be a fresh

start. My mother

even remarried.

Eventually, regard-

less of the changes,

my conduct re-

sumed. Then my

behavior escalated

at full throttle. This

led to my involve-

ment in the court

system. My mom

worked with the

school system and

community mental

health in search of

a solution to my be-

haviors. I was start-

ed on medications.

Then I was often hospitalized for med

changes as a result of having my diag-

nosis altered. The process was drain-

ing for my family and me, and it lasted

eight years. At home my mom made

many efforts to keep safety a priority.

She provided a safety plan at home

in case I lashed out or attempted to

inflict self-harm. She also arranged a

support system with wraparound, a

family strengthening process to keep

me from out-of-home placement and

to strengthen family values.

When a child with emotional

challenges is going through behavior

changes, a support system is vital. Not

only does the child benefit from the

support system, but their family does

as well. The support system I believe

in most is provided through the family

focused planning that is at the center

MY GREATEST ALLY

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

This article and others can be found at www.rtc.pdx.edu. For reprints or permission to

reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

Thus while the mentor him- or herself lized for children and youth affected merely receiving support may not be

may not become an enduring part of by mental health difficulties and their as potent as mutual exchanges of sup-

the young person’s social support net- families. The research reviews cited in port. It is worth considering how op-

work, the organization may continue this article include studies of a wide portunities to give and receive support

to link the youth with support oppor- variety of support interventions that can be built into future interventions.

tunities over time. focus on providing support to diverse The same reviews also suggest that

Other types of interventions de- populations, from people with chron- interventions would likely be more ef-

signed to build or increase support ic medical conditions to impoverished fective if greater attention were paid

from youths’ natural networks are not single mothers to recovering addicts. to matching a person’s support needs

well researched. In principle, wrap- This relatively small yet heteroge- with potential sources of support.

around aims to increase the social neous body of research may label cer- Some people, particularly those who

support available to youth as well as tain types of interventions “encour- are highly introverted or independent,

caregivers, but, as noted previously, aging” or “promising,” but evidence may not desire additional support,

the success of these efforts has not of their effectiveness is by no means even if their networks are relatively

been well studied. At least one strat- definitive. These studies can inform small. In general, women are more

egy for adding friends to the social interventions developed for our own likely than men to use social support

networks of children with disabilities field, but more work will need to be as part of their efforts to cope with

has been described (Cook, 2001), but done to design, implement, and evalu- stress and adversity (Taylor, Dick-

not as yet formally evaluated. ate programs suited specifically to our erson, & Klein, 2002) and may thus

needs. benefit more from intervention to in-

Conclusions and Cautions Several reviews of social support crease support. This implies that in-

interventions conclude by suggesting terventions should include an assess-

It bears repeating that we know that reciprocity may be an important ment of support needs and potential

relatively little about whether or how element in successful interventions. support resources. Armstrong (pages

social support can be created or mobi- Some research supports the idea that 19-22) describes some methods that

CCoonntt.. ffrroomm ppgg.. 66:: SStrengthening Supporttrengthening Support

of wraparound. This was more bene- and give me friendly advice, not lec- blessed to have such wonderful sisters.

ficial than one-on-one therapy. In fact ture me. And I was fortunate enough They are very dear.

it was not therapy at all. My entire to have many who would offer this I now realize that throughout these

family would meet for discussion in type of positivity throughout the hard times in my life, I had a wonder-

the comfort of our own home. Friends wraparound process and thereafter. ful family who loved and cared for me.

and other family members would also The toughest part of this family-fo- They will always be my greatest sup-

join in for many of our meetings. We cused process for me personally was port system. And now at 23, I am no

discussed our family and personal is- realizing how badly my issues had longer involved with Mental Health,

sues in a strength-based way. This affected those whom I love the most. and I am no longer on medications.

allowed us to better understand one Up to that point, it was hard for me I am trying to lead a positive life with

another and the full spectrum of the to think of anyone other than myself. a positive future to inspire those who

issues surrounding us so we could However, this process opened my eyes feel as though hope is out of reach.

target them together. There were mo- in the greatest ways. I began to realize And so I glance another peek out

ments of tear shedding, and hugging that everybody’s heart aches just as my the kitchen window. These snow-cov-

was common. During this process own, and my behavior had to change, ered hills are once again my dream-

I grew closer to my family members not only for my own good, but also for land. Glorious and content, they’ve

and my relationships with friends also the good of my family, especially my withstood my pain and forever they

grew stronger. loving sisters. All they knew is that I will stand as a symbol of my priori-

In my time of need, it seemed as had problems, and because of that I ties, to stay sound and pure with my

though everybody who had worked had to be the main focus. So they felt soul.

with me tried to be a therapist. But as though they had to put their own

this was not what I needed. I needed a feelings aside so I could get the help Craig Delano

friend; someone who would sit down I needed, and that makes me feel sad.

with me, listen to what I had to say Their understanding was sincere. I am

Winter 2006, Vol. 20 No. 1

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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are currently used for assessing avail-

able and/or potentially available so-

cial support.

While there is little enough re-

search on whether interventions can

increase social support over the short

run, there is even less informa-

tion about whether such in-

creases are sustained over time.

In fact, there is some evidence

that deterioration can follow

when support is withdrawn

(Rook & Underwood, 2000).

People planning social support

interventions should thus con-

sider carefully how to maintain

support once the intervention

has ended. Linking people to

supportive organizations is one

strategy for addressing this con-

cern.

Finally, it should be remem-

bered that most of the research

on social support focuses on

mitigating stress and manag-

ing threats and crises. Relatively

little attention is paid to the

role social support may play

in promoting thriving or posi-

tive development. Interpersonal

relationships are a source of

enjoyment as well as intellectual, ar-

tistic, and moral stimulation. Com-

panionship is a form of support that

may be particularly essential for pro-

moting experiences that enhance well

being. As we contemplate the design

of interventions, it is essential not to

overlook these important aspects of

social support.

References

Cohen, S., Underwood, L. G., & Got-

tlieb, B. H. (2000). Social relationships

and health. In Cohen, S., Underwood,

L.G., & Gottlieb, B. H. (Eds.), Social

support measurement and intervention: A

guide for health and social scientists (pp.

3-25). New York: Oxford University

Press.

Cook, J. ( 2001). Friendship facilita-

tion. Focal Point: A National Bulletin on

Family Support and Children’s Mental

Health, 15(2), 11-13.

Cox, K. F. (2005). Examining the role

of social network intervention as an

integral component of community-

based, family-focused care. Journal of

Child and Family Studies, 14, 443-454.

Cutrona, C. E., & Cole, V. (2000).

Optimizing support in the natural

network. In Cohen, S., Underwood,

L.G., & Gottlieb, B. H. (Eds.), Social

support measurement and intervention: A

guide for health and social scientists (pp.

278-308). New York: Oxford Univer-

sity Press.

Gottlieb, B. H. (2000). Selecting and

planning support interventions. In

Cohen, S., Underwood, L.G., & Got-

tlieb, B. H. (Eds.), Social support mea-

surement and intervention: A guide for

health and social scientists (pp. 195-219).

New York: Oxford University Press.

Helgeson, V. S., & Gottlieb, B. H.

(2000). Support groups. In Cohen, S.,

Underwood, L.G., & Gottlieb, B. H.

(Eds.), Social support measurement and

intervention: A guide for health and social

scientists (pp. 221-245). New York: Ox-

ford University Press.

Herrera, C., Sipe, C. L., & McClana-

han, W. S. (2000). Mentoring school-

aged children: Relationship development

in community-based and school-based pro-

grams. Philadelphia: Public/Private

Ventures.

Hogan, B. E., Linden, W., &

Najarian, B. (2002). Social sup-

port interventions: Do they

work? Clinical Psychology Review,

22, 381-440.

McFarlane, W. R. (2003). Fam-

ily psychoeducation and schizo-

phrenia: A review of the litera-

ture. Journal of Marital and Fam-

ily Therapy, 29, 223-245.

Rook, K. S., & Underwood, L.

G. (2000). Social support mea-

surement and interventions:

Comments and future direc-

tions. In Cohen, S., Underwood,

L.G., & Gottlieb, B. H. (Eds.),

Social support measurement and

intervention: A guide for health

and social scientists (pp. 311-334).

New York: Oxford University

Press.

Taylor, S. E., Dickerson, S. S., &

Klein, L. C. (2002). Toward a biology

of social support. In C. R. Snyder &

S. J. Lopez (Eds.), Handbook of positive

psychology (pp. 556-569). New York:

Oxford University Press.

Werner, E. E. (1995). Resilience in

development. Current Directions in Psy-

chological Science, 3, 81-84.

Janet S. Walker is Director of Re-

search and Dissemination for the Re-

search and Training Center on Family

Support and Children’s Mental Health

in Portland, Oregon. She is also Edi-

tor of FOCAL POiNT.

Melanie Sage, MSW, is a PhD

student in the Social Work Program

at Portland State University. She is

a Research Assistant at Portland’s

Regional Research Institute for

Human Services.

Winter 2006, Vol. 20 No. 1

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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Many states and communities

are working to strengthen

their child mental health systems by

supporting intensive home and com-

munity-based services for children

with serious emotional or behavioral

disabilities and their families. Fam-

ily-to-family support programs, often

operated by family-led organizations,

are an essential component of these

efforts. The President’s New Freedom

Commission on Mental Health sup-

ports this concept by recommending

that child-serving systems increase

the opportunities and capacities of

consumers to share their inspiration,

knowledge, and skills.

Family-to-family support has in-

tuitive appeal. In theory, families

who are facing similar challenges of

raising children with serious emo-

tional or behavioral disabilities can

find common ground and prevent

feelings of isolation or hopelessness

by sharing practical information, pro-

viding encouragement to each other,

and swapping stories of survival. But

the actual task of developing, imple-

menting, and sustaining meaningful

family-to-family support programs

presents major conceptual, logisti-

cal, and financial challenges. Few

scientific studies on effective family

support practices are available and

specific techniques for building fami-

ly-to-family support programs remain

ill-defined.

Parent Connections was a joint

project of Families Involved To-

gether (FIT), a parent-to-parent sup-

port organization, and faculty from

the Johns Hopkins School of Public

Health. This team of parents and

researchers worked longer than five

years developing, implementing, and

evaluating the program. The develop-

ment and evaluation of the project

was supported in part by a major

grant from the National Institute of

Mental Health.

This article is intended to highlight

program theory and format, chal-

lenges encountered, and key scientif-

ic theories and findings. This material

may provide insight and direction for

family support organizations, mental

health programs, and others wishing

to craft a useful approach to provid-

ing peer support for families in their

own communities.

Types of Support

We define support as “informa-

tion leading people to believe they

are esteemed and valued and that

they belong to a network of mutual

obligations” (Cobb, 1976). We view

Parent Connections as a method for

generating family-to-family support

by offering intensive personal atten-

tion and information-sharing oppor-

BUILDING FAMILY-TO-FAMILY SUPPORT PROGRAMS:

RATIONALE, GOALS, AND CHALLENGES

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tunities, thereby building a network

of mutual obligations among partici-

pating parents. As a practical matter,

this was achieved by linking “veteran”

parents with parents of school-aged

children with serious emotional or be-

havioral disabilities. Knowing that the

veteran parents had “walked in their

shoes” helped participating parents

feel a sense of trust and safety, which

in turn allowed them to expand their

ability to learn, make changes, and

manage the needs of their children

more successfully.

The staff of Parent Connections

dubbed the veteran parents Parent

Support Partners (PSPs). Our PSPs

had children over 18 years old who

had been identified as having emo-

tional or behavioral disabilities when

still in school. The PSPs worked with

seven or eight families and were paid

for up to 10 hours of work per week.

They made weekly telephone calls to

each assigned mother, and worked to

build a supportive relationship with

each family. The intervention also

included a series of 15 educational

workshops facilitated collaborative-

ly by parent advocates and mental

health professionals. The workshops

provided opportunities for PSPs and

families to meet each other, strength-

en support networks, and share exper-

tise. The goal of these activities was to

provide informational, affirmational,

and emotional support to participat-

ing parents.

Informational Support is shared in-

formation about childhood behaviors,

developmental transitions, parenting

skills, coping techniques, and com-

munity resources. This type of sup-

port can be offered over the phone or

by mail. However, a large part of this

support occurred during our educa-

tional workshops. These sessions pro-

vided a safe environment for parents

to admit what they didn’t know, the

first step toward building a stronger

foundation of knowledge. In addition,

the PSPs helped their assigned moth-

ers identify difficulties, issues, or un-

met needs, and then modeled various

ways to find alternative strategies for

resolving these issues or meeting these

needs. PSPs also encouraged mothers

to discuss their children’s care with

mental health and education profes-

sionals and to increase their access to

relevant and up-to-date information,

knowledgeable advice-givers, and

needed services.

Affirmational support is focused

on enhancing a mother’s confidence

in her own parenting. PSPs sought to

reassure mothers that their concerns

were appropriate and shared by others

in similar situations. To do this, PSPs

continuously sought out opportunities

to identify parenting competencies.

This feedback encouraged mothers’

positive self-evaluations and elevated

them to the roles of “expert” and po-

tential “advisor.”

The PSPs provided emotional sup-

port by establishing a relationship of

trust. They aimed to listen closely to

a mother’s concerns, demonstrate a

continued interest in her viewpoints

and experiences, and communicate

an understanding of her feelings.

PSPs also encouraged the growth of

mothers’ natural support networks

by discussing means for finding and

strengthening emotionally supportive

relationships with relatives, friends,

church members, and other key peo-

ple.

Program Theory

Parent Connections is a family-

to-family support program that en-

compasses five primary principles or

assumptions that are drawn from spe-

cific theories of social support and re-

lated concepts. (For further details see

Ireys, DeVet, & Sakwa, 2002.)

A strong support network linking

relevant information and resources

can improve parents’ responses to the

challenges of raising a child with a

serious emotional or behavioral dis-

order. Basic information about where

to get help, how to overcome adminis-

trative obstacles, and how to perform

effectively in crisis situations was pro-

vided through PSP contacts and the

educational workshops. Increasing a

parent’s knowledge level in this way

can contribute to more effective par-

enting, thereby improving a child’s

functioning and preventing further

deterioration of his or her mental

health.

Support can help parents deal

more effectively with their own wor-

ries and doubts. Virtually all parents

of children with serious emotional

or behavioral disabilities have serious

doubts about whether they have the

knowledge and emotional resources

required to help their children grow

into capable, independent adults. En-

couragement by a trusted supporter

can help parents overcome their fears

and manage their potentially crippling

anxiety.

Support can diminish feelings of

stigma. Parents of children with seri-

ous emotional or behavioral disorders

often cannot find naturally occurring

sources of support in their communi-

ties because stigma prevents parents

from freely discussing their child’s

emotional or behavioral disorders with

relatives, neighbors, or church congre-

gants. Without personal knowledge

of the causes, signs, and treatment of

children’s emotional disorders, family

members, neighbors, and others are

not likely to understand the special

challenges parents face. Too often,

this lack of empathy leads to blaming

and judgmental thinking. As a result,

the parent and child become isolated

from those who should serve as their

Encouragement by a trusted supporter can

help parents overcome their fears and manage

their potentially crippling anxiety.

Winter 2006, Vol. 20 No. 1

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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system of natural supports. The process

of family-to-family support essentially

“grafts” experienced parents into the

social network of families struggling

with their child’s behaviors and needs.

Family-to-family support may allow

professional treatment to work more

effectively. Parents who have sufficient

support may be more likely to stay in

treatment, develop collaborative re-

lationships with the child’s therapist,

make use of resources in the educa-

tional system, and implement effective

behavior management techniques at

home. Confident, knowledgeable par-

ents are more capable of partnering

with providers from various child-serv-

ing systems. Overall, family support

and education programs can increase

the value of mental health and educa-

tional services.

Building parents’ knowledge and

skills can produce a heightened sense

of efficacy, both at home and within

the mental health and education sys-

tems. Parent Connections designed

workshops to increase parents’ capacity

to identify and advocate for more ap-

propriate services to meet their child’s

needs, use behavior modification tech-

niques effectively with their child, and

be aware of their own strengths and

limitations. Better skills in these areas

can lead directly to behavior changes at

home and better access to appropriate

treatments.

Implementation Challenges

In the process of developing, imple-

menting, and evaluating Parent Connec-

tions, we encountered several obstacles.

First, we had to find the right PSPs. Al-

though many parents of children with

serious emotional and behavioral dis-

abilities want to “give back” and help

other parents, an effective PSP requires

additional attributes. These include be-

ing able to listen carefully, to distinguish

between “help” and “support,” and to

manage their own emotional reactions

to the struggles of other families. There-

fore, we required PSPs to be parents of

young adults who had received mental

health services as a child or adoles-

cent. This allowed them to communi-

For so many years, I wore an invis-

ible mask. Before I came to Fam-

ilies Involved Together, the acronym

F.I.T. meant Faking It ‘Till (I make

it). As a wounded child, one of my

disguises was laughter. Unfortunate-

ly, I made poor choices in men that

led me to becoming a single mother.

Though I love my son very much, his

special needs

presented great

challenges. The

responsibility

of motherhood

brought on ad-

ditional stress

that caused me

to indulge in

unhealthy be-

havior. Years

later, I finally

sought help from

a wonderful community program and

I began to put my life’s puzzle back

together. While this process set my life

on a better path, I had not totally let

go of my mask.

One day, I ran into a friend who was

working as a Parent Support Partner

at Families Involved Together. She

said FIT was looking for new sup-

port partners and that I should call

for an interview. I was accepted and

invited to participate in FIT’s Par-

ent Connections project. I attended

many hours of training that prepared

me to offer constructive encourage-

ment toward growth and insight by

parents just like myself. The sessions

were quite intense at times. We were

learning information and skills that

I wished I had known while raising

my son. Despite that regret, I noticed

that something new was happening

to me.

Eventually, I was matched with sev-

eral parents who were going through

what I had struggled with years be-

fore. Many began the Parent Connec-

tions workshops looking very down-

trodden. They felt as if they had come

to the end of the line. They expressed

great fear for their children’s future—

and their own.

My assigned parents and I spoke by

phone during the week and met in-

person at the scheduled workshops.

These educational sessions presented

ideas and skill-

building that

these parents

had never ex-

perienced. In

time, the par-

ents seemed

to develop a

sense of trust

and affection

when we spoke

or met. When

they graduated,

the mothers were no longer sad and

apprehensive. They were bright and

hopeful. They shared with me how

much the program—and I—had

meant to them. I listened to them tell

me how much I had done for them

and the changes they were able to

make because of my friendship and

support.

I was, of course, very proud and

happy for their success knowing I had

contributed to it. But more than that,

I also began to realize that, some-

how, my own life had also totally

changed—a metamorphosis of sorts.

I had dropped my wooly outer layer,

which was my defense mechanism.

I had emerged as something quite

beautiful. Now clothed with knowl-

edge and truth, I was able to fly above

past circumstances and soar into my

own fantasy. I had arrived! I finally

had discovered my true “FIT” and

become the person I was meant to

be—one without a mask, one without

pretense.

Lena Gladden

UNMASKING LENA

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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cate their personal experiences while

maintaining some emotional distance

from the day-to-day issues of raising

a young child. We also established

a three-stage process for recruiting

PSPs. In the first stage, we developed

an interview that assessed a mother’s

ability to maintain boundaries and ob-

jectivity, avoid being judgmental, and

encourage trust and self-confidence in

others. In the second stage, all parents

who were accepted on the basis of the

interview participated in a short-term,

skill-building training. This served as a

way for us to get to know them and for

them to get to know the program. In

most cases, those who were not suited

for the position dropped out. Those

who stuck with the program partici-

pated in the third stage of the train-

ing: an intensive program designed to

further strengthen their listening and

communication skills.

Second, we had to find a way to

invite families to participate in Par-

ent Connections. We pursued several

routes, including a general invitation

to families associated with Families

Involved Together. In addition, we

worked with all of the major child

mental health clinics and schools in

the area to help identify parents who

might be interested in participating.

Third, we needed to provide con-

tinuing support to PSPs during the

months in which they were working

with families. To accomplish this,

PSPs met weekly with the program

directors to share their own concerns,

find their own affirmational support,

and develop effective ways of respond-

ing to difficult situations that arose

with their assigned families. The soli-

darity that developed within the team

of PSPs was critical in sustaining their

commitment to the project.

Fourth, it was important for ad-

ministrative purposes to ask PSPs to

document their work. The PSPs were

effective listeners, coaches, and advo-

cates but, for some, recording their

good works proved quite formidable.

The process for tracking their activities

had to be modified more than once to

accommodate the needs of both the

PSPs and supporting agencies. Even-

tually reporting forms were developed

that combined the right levels of sim-

plicity and comprehensiveness.

Our final hurdle was obtaining ad-

ditional funding to continue the pro-

gram after the research project was

complete. Despite positive results

from the evaluation, it was difficult to

identify a continued funding source

because this type of program is not

typically reimbursable under public

or private health insurance plans. We

were, however, able to combine the

dollars of two private foundations to

continue Parent Connections for one

year beyond the study.

Evaluation Results

We evaluated Parent Connec-

tions using a randomized controlled

clinical trial design with two groups:

a low-dose control group and an ex-

perimental group. The control group

received a packet of information on

services and resources for families of

children with serious emotional disor-

ders. The experimental group received

the identical information packet. Ad-

ditionally, they were offered the op-

portunity to participate in the full Par-

ent Connections program.

Although the evaluated program

lasted 15 months, data were collected

at enrollment and 12 months post-

enrollment. We used this approach

because our experience with similar

studies suggested that measuring out-

comes at the very end of a project can

lead to detecting temporary negative

effects brought about by a sense of

loss as the program is terminating.

This common response by partici-

pants can obscure an otherwise more

enduring positive effect. In addition,

we viewed one year as a more natural

intervention assessment period than

15 months.

The project utilized data collected

from 257 families enrolled at base-

line. We examined effects on child

functioning and the impact on ma-

ternal mental health and perceived

support. Perceived social support was

measured using items from the Mul-

tidimensional Social Support Inven-

tory (MSSI; Bauman & Weiss, 1994).

These items were used to assess per-

ceived availability of support across

five areas, including having someone

to confide in or having someone to

talk to about the child’s needs. For ex-

ample, one item asks: “Does anyone

show that they are interested in and

want to understand your concerns

about raising a child with a serious

emotional or behavioral disorder?”

Items from this scale have been used

in prior evaluations of similar parent

support programs (Ireys, et al., 1996;

Ireys, et al., 2001). To assess perceived

adequacy of support, interviewers

asked parents whether they got the

support they needed all, most, some,

or none of the time.

On the measure of perceived

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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breadth of support, the mean increase

for the experimental group was sig-

nificantly greater than for the control

group. At the second data collection

point, all participants were asked

“whether there was ever a time in the

last year when you wished you could

have talked to someone about your

child’s condition,” and, if they did

wish this, whether they actually talk-

ed to anyone. About three-quarters

of mothers in the experimental group

indicated that they wished they could

have talked to someone and of these

about three-quarters actually did so.

In contrast, about two-thirds of moth-

ers in the control group indicated that

they wished they could have talked to

someone and of these only about half

actually did so.

To assess changes in maternal

mental health status, we examined

whether the two groups differed with

respect to change in levels of anxi-

ety. Nine percent of the mothers in

the control group moved from high

anxiety at baseline to lower anxiety 12

months later. In contrast, 22 percent

of the mothers in the experimental

group moved from high to lower anxi-

ety.

Conclusion

This study is an example of a

methodologically strong evaluation of

a theory-driven, family-to-family sup-

port program for low-income families

with high-risk children and multiple

other stressors. Overall, the study pro-

vides evidence that Parent Connec-

tions produced modest positive effects.

It is not surprising that the program

demonstrated only a modest impact

in light of the many factors that influ-

ence the functioning of low-income,

urban families. Nevertheless, what we

have learned represents an important

step toward a better understanding of

how to support parents of children

with serious emotional or behavioral

disabilities. Our findings should en-

courage further study of Parent Con-

nections or other well-defined models

of family-to-family support.

References:

Bauman, L. & Weiss, E. (1994, May).

Psychometric properties of the Multi-

dimensional Social Support Inventory.

Paper Presented at the Psychosocial

and Behavioral Factors in Women’s

Health Conference. Washington, DC.

Cobb, S. (1976). Social support as a

modifier of life stress. Psychosomatic

Medicine, 38, 300-314.

Ireys, H., DeVet, K. & Sakwa, D.

(2002). Family support and educa-

tion. In B. Burns & K. Hoagwood

(Eds.), Community Treatment for Youth.

New York: Oxford University Press.

Ireys, H., Chernoff, R., DeVet, K., &

Kim, Y. (2001). Maternal outcomes

of a randomized controlled trial of

a community-based support program

for families of children with chronic

illness. Archives of Pediatrics and Ado-

lescent Medicine, 155, 771-777.

Ireys, H., Sills, E., Kolodner, K., &

Walsh, B. (1996). A social support

intervention for parents of children

with Juvenile Rheumatoid Arthritis:

Results of a randomized trial. Journal

of Pediatric Psychology, 21, 633-641.

Diane Dvoskin Sakwa has ad-

dressed the need for change in child

and adolescent systems of care as both

parent and advocate by sharing her

encouragement, knowledge, and voice

with thousands of families and profes-

sionals for close to 20 years.

Henry T. Ireys is currently a Se-

nior Researcher at Mathematica

Policy Research, Inc., in Washington

DC and for many years has been ex-

amining the effectiveness of support

programs for families of children with

special needs.

Building parents’ knowledge and skills can

produce a heightened sense of efficacy, both

at home and within the mental health and

education systems.

Winter 2006, Vol. 20 No. 1

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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Parents in Kansas

whose children have

or are at risk of emotional

and/or behavioral prob-

lems call Keys for Net-

working seeking help. Par-

ents call when they cannot

get the response they need

from agencies. Most report

feeling isolated, alienated,

disconnected, alone, or

abandoned, even by fam-

ily members. They often

doubt their ability to help

their own children. In the

process of learning how to

obtain effective plans and appropriate

programming, however, they become

connected with a statewide social sup-

port network that offers contact with

other parents who have had similar

experiences. Keys for Networking, or

“Keys,” is this statewide organization.

It is managed and staffed by parents.

Since 1987, Keys has offered peer-

to-peer support to parents so they can

advocate first for their own child, and

then for other children. Not only do

Keys’ parent staff meet callers’ imme-

diate needs for information, they strive

to connect parents to other parents so

they can support each other. Keys de-

velops and sustains the network by

supporting long-term relationships

between Keys and parents, among

parents in the network, and between

parents and their child’s providers.

With targets and benchmarks to

engage parents at their level of experi-

ence and interest and to affirm their

role as primary decision maker for

their child, the Keys Targeted Parent

Assistance (TPA) model includes pro-

cedures, interventions, and technolo-

gy-based tracking mechanisms. Devel-

oped with support from the American

Institutes for Research, TPA provides

the system infrastructure to create

and sustain parent connections. With

TPA, the parents who have received

help and become connected to the

network develop into help-givers and

sustainers of the network: They hold

the keys to networking.

TPA is based on a ten-level con-

tinuum that was developed from Dr.

Barry Kibel’s Outcome Engineer-

ing (Kibel, 1996) and Journey Map-

ping (Kibel, 2000). The continuum

describes the movement of parents

toward family and system advocacy.

Using the continuum, Keys staff de-

tails each parent’s progression from

seeking help to emerging as a problem

solver to becoming a systems change

agent. Figure 1 depicts the continu-

um’s ten levels of parent engagement

and groups them into three stages: Ini-

tiation, Solution-Focused, and Expand-

ing Interests.

In the Initiation stage, the three lev-

els are about “getting to know you.”

Parents at level 1 call Keys seeking

information about what Keys can

do for them. Keys staff provide im-

mediate answers to “What do I do

know?” questions and offer Keys and

local service contact information and

emotional support. Parents remain

at level 1 until they initiate a second

contact. At level 2, parents may say,

“I am interested in more

information. Tell me more

about exactly what I can

do.” Staff limit discussion

to the questions asked and

encourage parents to at-

tend Keys’ trainings related

to their interests. They of-

fer mileage, childcare, lodg-

ing, and travel connections

with other parents from

their geographical area.

Connecting families, with

their permission, builds

relationships and increases

the likelihood that new

parents will attend. It sustains the

commitment of experienced fami-

lies and involves them as mentors to

new families. Parents move to level 3

when their actions—such as complet-

ing training—indicate deepening in-

volvement. The support relationship

between Keys and parents at level 3

evolves into exploring larger system

and family issues.

At the Solution-Focused stage

(levels 4-6), parents work with staff

on strategies to improve and monitor

planning documents, secure neces-

sary services, and integrate program-

ming. At level 4, parents contact Keys

frequently and Keys staff call them

to revise Individualized Education

Plans, mental health treatment plans,

wraparound plans, and other formal

service planning efforts. Staff may

attend meetings to support the fami-

lies. At level 5, parents report that

some part of the original problem

that brought them to Keys is resolved:

“My child is back in school,” or “We

have attendant care.” At level 6, par-

ents have resolved their initial prob-

lem and decide to take on additional

areas of concern. Parents at this level

may say, “Help me think about how

to do this.” During this stage, staff en-

THE “KEYS FOR NETWORKING”:

TARGETED PARENT ASSISTANCE

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gage parents to expand their skills and

self-confidence. Staff members invite

them to attend sophisticated trainings

on topics such as IDEA legislation

and wraparound facilitation.

The Expanding Interests stage (lev-

els 7 through 10) focuses on outreach

to others and system issues. This stage

begins at level 7 when parents offer to

help other families. They may say,

“I would like to get involved. How

can I help someone else?” or “I don’t

want what happened to me to happen

to anyone else.” These words denote

expanding interest outside one’s own

family. Responding quickly to these

statements with training and help-

ing opportunities is critical. At level

8, parents complete training to help

others. At level 9, parents assist other

parents. They call Keys often, not for

themselves, but for advice to further

their work with others. They are at-

tending meetings, revising plans, and

sharing advice with other families. At

level 10, parents ask for assignments

to work on local and state commit-

tees, join boards, testify to legislative

bodies, and participate in policy-mak-

ing efforts. They serve as vocal and

effective system advocates, offering

testimony in very public forums. They

support and organize other parents

and sustain the family organization

and state services. They have come

full circle, returning the help they got

from Keys to other families in a wide

variety of ways, facilitated by an orga-

nization whose mission is to build a

statewide network of informed fami-

lies.

Monitoring individual parents and

groups of parents along the TPA con-

tinuum, Keys staff members provide

information and support appropriate

to the parents’ readiness level, while

also promoting movement to higher

levels. TPA marks change increments

in parents’ engagement with Keys and

with service providers and systems. It

documents the interventions offered

and tracks the usefulness to parents

of Keys’ suggestions by check-in calls

to parents at least monthly that al-

low staff to ask, “What is working?”

When parents do not respond or do

not show up at a meeting, staff mem-

bers examine contact notes to iden-

tify problems with Keys’ intervention.

They may determine that the interven-

tion was sound but was offered at the

wrong level of the parents’ readiness

to use it.

The majority of parents move

quickly through the first three lev-

els (averaging 2.5 months per level),

slowing when they reach level 4. Lev-

els 4-6 average 4.6 months per level,

and levels 7-10 average 6.3 months per

level. Graph 1 (adapted from Cheon

& Chamberlain, 2003) shows the av-

erage duration of time at each level.

Time is an important consideration in

building relationships and establishing

reasonable expectations when asking

parents to deepen their involvement,

complete training, attend meetings,

advocate for their child, or commit to

system change efforts.

The Keys TPA model provides

the structure to document process

and outcomes. Staff members track

the interventions delivered and note

which ones move parents forward.

Data from a study conducted by the

University of Kansas School of Social

Welfare (Cheon and Chamberlain,

2003) show that parents move for-

ward over time along the continuum.

The data shows that parents who

reach higher levels of engagement on

the TPA continuum stay active with

Keys over longer periods of time than

parents scoring at lower levels. Only

26.3% of low-level (1-4) parents main-

tain contact with Keys for two years,

compared to 67.2% of high-level (5-

10) parents. Most parents who be-

come inactive do so at level 1 (50.4%).

The data shows that only 29% of mi-

nority parents remain active after two

years compared to 44.5% of Cauca-

FIGURE 1: TPA CONTINUUM

TPA CONTINUUM: 10 LEVELS

1. Seeks information

2. Initiates additional contact

3. Commits to address problem

4. Works on Problem

5. Resolves initial problem

6. Takes on new problems

7. Offers to help others

8. Completes training to help others

9. Helps others

10. Impacts local, state, national policy

1 2 3

INITIATION SOLUTION-FOCUSED EXPANDING INTERESTS

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sian parents.

To improve retention and promote

depth of engagement, staff must re-

spond quickly at lower levels (1-3) to

parents needs with interventions that

parents find useful and that are appro-

priate to parents’ concerns and inter-

ests. Concerns vary by stage, as do

parents’ ability to use the information

provided. At the Initiation stage (lev-

els 1-3), 30.4% of parents ask about

Keys program information, 20.3%

have service system concerns (mental

health, child welfare, juvenile justice),

and 19.8% have specific school issues.

They really want to know most what

Keys can offer and what service pro-

viders should do. At this stage, the

most useful intervention is to answer

the specific questions asked. With very

different interests at the Solution-Fo-

cused stage (levels 4-6), the majority

of parents want help resolving specific

service concerns. At the Expanding

Interests stage, 30.3% of parents had

questions about Keys’ programs and

services, 28.9% had no concerns, and

19.7% had service system concerns.

In the Expanding Interests stage, par-

ents want Keys to support them to

assist other parents, to invite them to

serve as spokespersons at events, and

to bring parent voice to boards. Keys

staff link these parents to people and

programs where they can serve, train

them in sophisticated content areas,

and encourage them to call when they

need help with their own children.

Table 1 (also adapted from Cheon

and Chamberlain, 2003) identifies the

frequency of Keys’ interventions of-

fered by stage. In the Initiation Stage,

when most parents call to learn what

Keys can do for them, 46.6% of the

interventions involve description of

Keys’ services and an invitation to

Keys events. During the Solution-

Focused stage, Keys’ most frequent

interventions are discussing options

and following up to make sure issues

are resolved. At the Expanding In-

terests stage, the interventions focus

on linking these advanced parents to

Keys activities where they can serve

as spokespersons and following up

to provide them with what they have

asked of staff.

Bobbie’s story illustrates the jour-

ney of one parent who has benefited

from TPA and demonstrates her

growth from family crisis to fam-

ily and systems advocacy. Her testi-

mony shows her commitment to her

own children and her drive to learn,

to transfer what she knows to help

other families, and to build service

pathways across Kansas for families

whose children have serious emotion-

al and/or behavioral problems. Her

children still have many problems, but

her capacity to manage them and re-

late effectively to the service world has

changed dramatically. She is a parent

who Keys helped and who now helps

Keys and all Kansas families.

My interest in advocacy began six years

ago when I met the people at Keys for Net-

working. Before I knew the Keys staff, I

was too afraid to leave my house. I was

raising four children on my own. In May

1999, I attended a conference in Topeka.

Keys staff held parent information meet-

ings and provided childcare during these

meetings. It was at this meeting that I got

their phone number. I kept the number al-

most a year before I called to ask questions

about why it was taking so long to get my

son’s testing done. I talked to Angie, who

told me she was a parent of a child with

serious emotional problems. She suggested

I talk to the IEP team about my concerns.

She called me back four days later to ask

how I did. I could not believe it. She invit-

ed me to a training about my child’s school

rights. I said yes on the spot. She told me I

could attend by phone and would not have

to leave home. At that training I connected

with other parents whose children had the

same problems as mine. I learned that my

son was eligible for additional services. I

requested additional testing and the school

agreed.

The Keys staff started calling me, to

check on me, they said. For almost a year,

I did not return their calls. They left mes-

sages to call if I needed help. In August of

2001, I attended the annual Keys Oscars

event. I nominated my son’s case manager

for an award, which she won. In October

2002, Keys hired me to bring parents to a

meeting with the Department of Educa-

tion about the connection between NCLB

[the federal No Child Left Behind Act] and

reauthorization of IDEA [the Individuals

with Disabilities Education Act]. About

this time, my younger son started getting

in trouble. I knew what to do. I asked for

a special education evaluation and started

him on an IEP. I started thinking maybe

other parents could use my help. I attended

GRAPH 1: LEVEL ACHIEVEMENT SPEED

Graph 1: Duration of Stay at Levels by Month

2.91

2.02

4.41

4.98

4.45

4.96

6.28

7.56

2.55

Level

Months

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benefits them and allows them to give

back what they learn. TPA provides

opportunities for parents to affiliate

with a large body of Kansas parents

who represent the 70,000 children

(10% of Kansas’ youth population)

whom the Kansas State Department

of Social and Rehabilitation Services

estimates have serious emotional dis-

turbance. They see that they are not

alone. As parents grow in their self-

advocacy abilities, they also experi-

ence a renewed (and in some cases

new) sense of self-worth and capacity

to help others. When parents take the

step of offering to assist and advocate

for other families with Keys’ support,

their sense of belonging and feelings

of reciprocal services to Keys and to

the community of parents is strength-

ened. Parents who experience success

in helping other families recognize

the magnitude of need on a system-

wide level and are welcomed to the

network of parent advocates through

trainings and meetings, and they are

given other opportunities to speak for

children and families in policy-mak-

ing activities.

References

Cheon, J., & Chamberlain, R. (2003).

Targeted parent assistance: What Keys for

Networking, Inc. did for the families and

children with mental health problems in

Kansas. [Unpublished manuscript].

University of Kansas School of Social

Welfare, Lawrence, KS.

Kibel, B.M. (1996). Evaluation using

results mapping. New Designs for Youth

Development, 12, 9-15.

Kibel, B.M. (2000). Outcome engineer-

ing toolbox. Pacific Institute for Re-

search and Evaluation.

Jane Adams is Executive Director

of Keys for Networking, the statewide

organization of the Federation of

Families for Children’s Mental Health.

Dr. Adams represented the child fam-

ily consumer voice on the President’s

New Freedom Commission on Men-

tal Health, 2003.

Elizabeth Westmoreland ana-

lyzes Keys’ monthly TPA records and

reviews them for progress and suc-

cess/failure of interventions offered.

Her adult sister and brother and her

mother have chronic mental illnesses.

Corrie Edwards is Program Direc-

tor at Keys for Networking. Corrie has

a sister who has experienced chronic

mental and emotional problems.

Sarah Adams is Director of Infor-

mation Systems and programmer for

the Filemaker Pro data base, which in-

tegrates daily journaling by staff with

the Keys 1-10 targeted outcomes.

wraparound and parent support

trainings and then called Keys for

direction on how I could help

a family get mental health ser-

vices for their child. In March

2003, Keys called to give me

information about legislative

issues and encouraged me to

talk to senators and representa-

tives if I cared to discuss these

topics. They gave me my legis-

lators’ names and phone num-

bers. I was invited to attend

Mental Health Advocacy Day

at the Capitol. In July of 2003,

Keys invited me to serve on their

NCLB state advisory council.

In May 2004, Dr. Adams called

to ask if I would help a family prepare for

a wraparound meeting so their child could

come home from the hospital. I did. Also,

the Governor appointed me to the Mental

Health Services Planning Council. At that

point, I was feeling pretty connected.

Then in July my daughter tried to com-

mit suicide. I was so overwhelmed I did

not know where to turn. Keys staff came

to my aid and fast. They kept telling me I

was a good mother and that I knew what

was best for my child. They said they were

behind me all the way. They encouraged

me to ask for a 504 Plan to help my daugh-

ter succeed in school. In September 2004,

I testified at the Capitol, encouraging

the legislature to develop policies against

school seclusion and restraint. In May

2005, I facilitated a group at the Freedom

Commission Goal 4 Summit with over

200 people. I brought my daughter and

she participated. Recently, I called for help

with my son’s IEP and the wording for

his behavior plan. The problems with my

children don’t stop. Most of the time I am

able to handle them. I know where to get

help when I need it. I am not afraid any

more to ask for help. Other parents in my

community see me as a resource when they

need help. And, through me, they see Keys

as a resource when I cannot help them.

Summary

TPA is a reciprocity model. Parents

who seek help become help givers. By

design, they join a state network of

natural and professional supports that

Interventions Initiation Solution-

Focused

Expanding

Interests Total

Provide

Information 6.8% 12.4% 14.3% 10.9%

Discuss options 13.2% 22.9% 15.6% 19.2%

Follow up issues 18.3% 35.0% 37.7% 30.2%

Refer to others 7.3% 7.7% 2.6% 7.0%

Provide advocacy

& action 7.0% 9.1% 6.5% 8.4%

Describe and/or

invite to Keys

programs/events

46.6% 12.9% 23.4% 24.2%

TABLE 1: INTERVENTIONS OFFERED BY STAGE

[MOST FREQUENT HIGHLIGHTED]

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This article reviews a number of

techniques for assessing a fami-

ly’s social support network. Some of

the techniques are typically used in

care planning or treatment to gather

information about support that can be

mobilized to help families meet needs

or reach goals. These assessments are

usually easy to use and can be adapt-

ed for use with adults, adolescents, or

children. Other techniques are more

formal and are used to measure social

support for research and evaluation

purposes.

Techniques for assessing social

support are valuable in a wide range

of planning, intervention, and evalu-

ation contexts; however, this article

focuses on how they can be used

by wraparound teams or programs.

Wraparound is a collaborative, fam-

ily-driven process for creating indi-

vidualized plans of care for children

and youth with emotional or behav-

ioral difficulties. One of the principal

goals of the wraparound process is to

strengthen the family’s social support

and community connections.

Informal Assessment

Social support assessments are use-

ful in the wraparound process because

they help the team pay attention to

important information that may oth-

erwise be overlooked. Given the em-

pirical evidence for the importance of

social support for families caring for

a child with a disability (Beresford,

1994; McDonald, Gregoire, Poertner,

& Early, 1997; Snowdon, Cameron,

& Dunham, 1994), the identification

of actual and potential social support

resources is an essential part of the

team’s assessment process. Individuals

who offer informal supports to parents

or youth can be valuable resources in

the implementation of a plan of care.

TECHNIQUES FOR ASSESSING SOCIAL SUPPORT

What is more, these individuals will

probably be available for the youth/

child and family after wraparound and

other formal services have ended.

An ecological map or eco-map (fig-

ure 1) is one technique that teams can

use to show a family’s relationships

with helping resources. To create an

eco-map, the team begins with a piece

of paper that has a large circle (repre-

senting the family) in the middle, and

a number of smaller circles around

the larger circle. Family members

are asked to identify both people and

services that serve as resources for

them. Possible resources are extended

family, church, recreation activities,

friends, health care, and school.

The family then indicates the nature

of the connections between themselves

and the resources by drawing different

kinds of lines between the large circle

and the smaller circles, and/or using

a descriptive word that can be writ-

ten on the map. Typically, a strong

positive connection is indicated by a

solid line, a moderate connection by

a broken line, and a stressful connec-

tion by a line with slanted lines drawn

through it. Arrows can also be used

to illustrate whether the relationships

and flow of resources are reciprocal,

or in one direction only. The team can

use the information on the completed

map to identify supports that may be

useful in the development of the ser-

vice plan and to identify gaps where

additional supports may be needed.

Another tool for depicting the rela-

tionships between a caregiver and her

FIGURE 1: ECO-MAP

Mental

Health

School

Social

Services

Church

Little

League

Coach

Anne

age 34

Brian

age 12

Mother’s

Boyfriend

Sister

Eco-Map by

Jan M. Markiewicz

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social systems is the Social Network

Map (Tracy & Whittaker, 1990). This

instrument attends to both the struc-

ture (the number and quality of social

relationships) and the function (the

various types of supportive exchanges)

of informal social supports. A circle

mapping technique is used to portray

network members and a grid is used to

identify the supportive and non-sup-

portive functions of relationships. For

example, who provides what types of

supports, which relationships are con-

flicted, and which are reciprocal? In-

formation is collected about network

size, reciprocity, perceived availability

of support, closeness, directionality,

stability, and frequency of contact.

There can be a number of advantag-

es of using the Social Network Map.

The map helps to identify and evalu-

ate not only resources but also sources

of stress and strain within the family’s

social environment. Responding to

the mapping and grid questions helps

caregivers review existing resources

and identify new sources of poten-

tial support. Using the tool may also

provide a vehicle for discussing other

issues, such as current stressors, that

the caregiver may be experiencing. Fi-

nally, caregivers sometimes find that

using the instrument is empowering,

because it helps identify specific steps

they can take to use their networks

more effectively.

The Community Connections and

Team Composition Questionnaire,

ed Funding Evaluation Team (2001),

creates a list of the individuals, ser-

vices, and activities that a youth has

been connected to over the past three

months in five categories: family,

friends, school/work, community, and

formal services. After all the supports

are listed, the parent rates the strength

of the connection on a scale of 0 to

3, with 3 being the strongest connec-

tion. As a final step, the parent identi-

fies the members of the wraparound

team, if there is

one, and provides

information about

how often each

person attends the

team meetings and

the types of sup-

port that the team

member provides

for the parent and/

or the child.

The EMQ

Connectedness

Model (EMQ

Children & Fam-

ily Services, 2003)

is another tech-

nique that is used collaboratively with

a child and family to discover social

supports and connections. The tech-

nique is used to generate a Connected-

ness Diagram (Figure 2). The diagram

begins with a genogram, which shows

the child’s biological relationships

using horizontal tiers for the child’s

generation, parents’ generation, and

grandparents’ generations. This part

of the diagram is done in blue. The

next step is to identify the individuals

who the child loves, and by whom the

child feels loved. These connections

are done in red, to represent the heart,

and may extend beyond the biological

relatives and include friends, teachers,

coaches, siblings, foster grandparents,

etc. The color green, standing for the

fertile and creative mind, is used to

represent those from whom the child

learns and those the child teaches.

These may include teachers, siblings,

aunts and uncles, coaches, and others

with whom the child has a positive

connection. The spiritual dimension

is diagrammed in yellow, represent-

ing the light of the soul. As each of

these individuals and resources is

identified, the team can ask whether

they can be mobilized as a strength or

support, or whether they can provide

a specific activity that can be built into

the child’s service plan.

Teams should keep several things

in mind when assessing social sup-

port using any of these techniques.

First, information gathered through

such a process may be limited since

the data is self-reported. It can be af-

fected by factors such as the type of

social support, the individual’s recall

skills, and social desirability. Through

using the instrument, the team may

overestimate or underestimate the

social network’s strengths and capac-

ity for offering support, as well as the

family’s capacity for receiving sup-

port. Interpersonal relationships also

change over time, and change may be

particularly likely when the team at-

tempts to increase the support offered

by particular individuals in a family’s

interpersonal network. Thus, the team

should remember that the assessments

provide only a starting point for an

evolving understanding of the family’s

social network and its potential for of-

fering support.

Any structured instrument can

also miss population-specific or cul-

tural nuances related to social sup-

port. For example, in one study of so-

cial support, parents of a child with a

chronic disability reported the unique

challenge of resource maintenance

within their support network (Breg-

man, 1980). Given the long-term na-

ture of their child’s challenges, par-

ents’ supports can burn out unless

parents direct attention and resources

into maintaining and re-fueling the

members of their support network. In

addition, reciprocity with the social

support network is difficult because

the parents’ needs are often large

and ongoing. A structured technique

may miss these aspects and, thus, ig-

nore the risk of the family depleting

or losing a vibrant support network.

Cultural differences in the types of in-

teractions that are seen as supportive

have been documented. People from

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different cultures also may have differ-

ent ideas about the kinds of support

or resources that can be appropriately

exchanged between friends and rela-

tives. Being aware of these differences

can help the team make adjustments

as new information about a family’s

social support network emerges over

time.

Formal Assessment

The techniques that are described

above are useful for child and fam-

ily teams because they are directly

related to the team’s purpose--the

development and implementation of

an individualized service and support

plan. In research and formal program

evaluation, social support is often in-

cluded as an independent variable,

contributing to positive child and

family outcomes, or as a dependent

variable when the research question

is about how social support can be fa-

cilitated and maintained. There are a

number of standardized instruments

that are used to assess social support

in these studies.

The Inventory of Socially Sup-

portive Behaviors (ISSB; Barrera,

1981) is a 40-item self-report measure

of received support. Its purpose is to

gather information regarding the sup-

port recipient’s perceptions of avail-

able social support. Respondents are

asked to assess the informal supports

received from different individuals

during the past 30 days using a 5-point

scale from 1 (not at all) to 5 (about ev-

ery day). Concurrent validity of the

ISSB total score with measures of net-

work size has been demonstrated with

correlations of .24 and .42 (Barrera &

Sandler, 1984). Internal consistency

coefficients range from .90 to .94,

with a test-retest reliability over a one-

month interval of .80 (Barrera, 1981).

The Quality of Relationships In-

ventory (QRI) was developed to as-

sess perceived availability of support

in specific relationships and is based

on the interactional-cognitive model

that distinguishes between general

and relationship-specific perceptions

of social support. The QRI is com-

posed of three separate dimensions

labeled support, depth, and conflict.

The QRI is a self-report questionnaire

with 25 items that participants rate us-

ing a four-point scale regarding their

perceptions of a specific relationship.

It takes approximately four minutes to

complete for each relationship. Stud-

ies testing the psychometric properties

and validity of the QRI scales reflect a

broad range of methodologies, includ-

ing cross-sectional, longitudinal, ex-

perimental, observational, and retro-

spective designs. Internal consistency

for each of the scales has been shown

to be high, with Cronbach’s Alpha in

the .80’s and .90’s. In addition, QRI

scores have high test-retest reliability,

with correlations between scores on

each scale across a four-month period

ranging from .66 to .82, with an aver-

age correlation of .75 (Pierce, 1994).

FIGURE 2: THE EMQ CONNECTEDNESS MODEL

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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Some research studies also collect

data on social support through ob-

servations of child and family team

meetings. For example, observers will

record whether one or more natural

helpers are present at the meeting,

whether social support is mentioned

and/or assessed during the meeting,

and whether social support is includ-

ed in the family’s service plan.

Conclusion

Social support assessments are

obviously useful in both practice and

research. Informal assessments help

stimulate thinking about ways that

interpersonal relationships can be

mobilized to help children and fami-

lies meet needs and achieve goals.

More formal assessments help devel-

op knowledge about whether or not

strategies designed to increase social

support actually succeed in doing so,

and whether increasing social support

contributes to other positive outcomes

for children and families. It is impor-

tant to remember, however, that these

assessments are only approximations

of what a family’s “real” social sup-

port network may be. Social support

is a complex concept and a complex

phenomenon, and knowledge about

the best ways to measure social sup-

port continues to evolve.

References

Barrera, M. J., Sandler, I. N., & Ram-

say, T. B. (1981). Preliminary deve-

lopment of a scale of social support:

Studies on college students. American

Journal of Community Psychology, 9,

435-447.

Beresford, B. A. (1994). Resources

and strategies: How parents cope with

the care of a disabled child. Journal of

Child Psychology & Psychiatry & Allied

Disciplines, 35, 171-209.

Bregman, A. M. (1980). Living with

progressive childhood illness: Paren-

tal management of neuromuscular

disease. Social Work in Health Care,

5(4), 387-408.

EMQ Children & Family Services

(2003). Using the EMQ Connected-

ness Model. Campbell, CA: Author.

King County Blended Funding Evalu-

ation Team (2001). Community Con-

nections. [Questionnaire]. Renton,

WA: Washington State Organization

of the Federation of Families for Chil-

dren’s Mental Health.

McDonald, T. P., Gregoire, T. K., Po-

ertner, J., & Early, T. J. (1997). Build-

ing a model of family caregiving for

children with emotional disorders.

Journal of Emotional and Behavioral

Disorders, 5, 138-148.

Pierce, G. R. (1994). The Quality of

Relationships Inventory: Assessing

the interpersonal context of social

support. In B. R. Burleson, L. A. Al-

brecht & I. G. Sarason (Eds.), Commu-

nication of Social Support (pp. 247-266).

Thousand Oaks, CA: Sage Publica-

tions.

Snowdon, A. W., Cameron, S., &

Dunham, K. (1994). Relationships

between stress, coping resources, and

satisfaction with family functioning in

families of children with disabilities.

The Canadian Journal of Nursing Re-

search, 26, 63-76.

Tebes, J. K., Kaufman, J. S., Adnopoz,

J., & Racusin, G. (2001). Resilience

and family psychosocial processes

among children of parents with seri-

ous mental disorders. Journal of Child

and Family Studies, 10(1), 115-136.

Tracy, E. M., & Whittaker, J. K.

(1990). The Social Network Map: As-

sessing social support in clinical prac-

tice. Families in Society, 72(8), 461-470.

Mary I. Armstrong is Assistant

Professor and Director of the Division

of State and Local Support at the de la

Parte Florida Mental Health Institute,

University of South Florida.

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TRAINING CENTER ON FAMILY

SUPPORT AND CHILDREN’S

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

The period of transition from child-

hood to adolescence is a challeng-

ing time for many young people. Even

in the best circumstances, it can be

daunting for adolescents to cope with

the biological, cognitive, emotional,

and social changes that are unfolding

in their lives. Supportive relationships

are vital for ensuring the continued

healthy development of young people

as they journey through adolescence.

To design interventions and policies

that enhance the availability of appro-

priate supports for young adolescents,

two key questions must be addressed:

First, who is best equipped to offer as-

sistance? Second, what are the ideal

amounts of assistance that should be

obtained from each type of support

provider?

Our recent research finds that sup-

port from both peers and adults is im-

portant to the healthy development of

young adolescents. Adjustment dur-

ing the transition to adolescence is af-

fected by whether or not youth receive

balanced amounts of support across

peer and adult sources. The finding

that adolescents need a mix of sup-

port from peers and adults is not sur-

prising. After all, this is an age group

known for its gravitation toward peer

companionship, as well as its com-

plicated and sometimes ambivalent

stance toward help from parents and

other adults. Our findings highlight

promising directions for innovation in

interventions for young adolescents,

and have noteworthy implications for

both practice and policy.

Research on Social Support

During Early Adolescence

In one of our recent studies, we in-

vestigated the levels of social support

that 350 young adolescents (grades 5-

8) received from both peers and adult

sources (e.g., parents, teachers) over a

two-year period (DuBois, et al., 2002).

Findings revealed that youth who re-

ported receiving higher overall levels

of combined support from peers and

adults exhibited significantly better

behavioral and emotional adjustment

throughout the course of the study.

We found that those youth for whom

there was a lack of balance in the di-

rection of greater peer- versus adult-

oriented support were at heightened

risk for behavioral problems such as

aggression and delinquency. When

youth receive support predominantly

from peers, this may be an indication

of estrangement or conflict in their

relationships with parents and other

adults. Under these circumstances,

young adolescents are less likely to

obtain the adult guidance and encour-

agement that they need to cope with

different challenges they encounter in

areas such as schoolwork or friend-

ships. We also found in a follow-up

study (DuBois & Silverthorn, 2004)

that youth who relied on peers as their

main source of support were more

likely to associate with other youth

who were exhibiting problem behav-

SOCIAL SUPPORT FROM ADULTS AND PEERS IN EARLY

ADOLESCENCE:

IT’S A BALANCING ACT

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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ior, thus amplifying their own risk for

engaging in such behavior.

At the same time, other research

we have conducted points toward an

equally troubling downside for those

young adolescents who have imbal-

anced relationships with adults ac-

counting for a disproportionately large

source of their social support. The ab-

sence of support from peers appears

to leave youth susceptible to emotion-

al difficulties, including symptoms of

anxiety and depression (DuBois, et

al., 1999). Such liabilities

likely stem at least in part

from the premium placed

on peer group acceptance

during early adolescence.

Peers may be especially

qualified to offer support

in many of the areas of

greatest concern to this age

group, such as their friend-

ships and appearance.

Application to

Interventions for

Young Adolescents

The research findings that we have

summarized have important implica-

tions for the design of effective inter-

ventions for young adolescents. To be

optimally beneficial, our results indi-

cate that programs, policies, and in-

terventions for this age group should

be devised with the goal of promoting

support from both peers and adults.

It is not uncommon for current inter-

ventions to focus predominantly on

promoting support from only peers

or adults (e.g., social skills training to

improve peer relationships, family in-

terventions to strengthen parent-child

relationships).

In our own research, we are ex-

ploring the value of introducing in-

novations focusing on social support

in mentoring programs for youth.

Mentoring programs currently en-

joy widespread popularity, with ap-

proximately 4,500 youth mentoring

programs operating in this country

(Rhodes, 2002). Mentoring programs

have focused most directly on increas-

ing the access of youth to social sup-

port through a relationship with a car-

ing adult volunteer. It is noteworthy

that youth participating in mentoring

programs have also demonstrated

improvements in their relationships

with peers (Rhodes, Haight, & Briggs,

1999). Evaluations of mentoring pro-

grams reveal that they can provide

benefits to youth in several areas, in-

cluding emotional, behavioral, social,

and academic adjustment (DuBois, et

al., 2002). However, the magnitude of

these benefits has typically been mod-

est. It thus appears that there is poten-

tial to strengthen mentoring programs

through promoting both adult and

peer support.

A Model for Integrating Adult

and Youth Support

Our current research is focused on

the development and evaluation of a

community-based mentoring program

for girls, GirlPOWER!, in partnership

with Big Brothers Big Sisters of Metro-

politan Chicago. The program is con-

sistent with the findings of our earlier

research in that it aims to foster sup-

port from both adults and peers. The

GirlPOWER! program is designed to

promote socially supportive relation-

ships between youth and their men-

tors as well as to promote supportive

relationships between other sources of

adult support and participating youth

(e.g., parents). An adult volunteer is

matched with a child with a commit-

ment to meet one-on-one two to four

times per month for at least one year.

Youth-mentor pairs structure their

own time together and may choose to

participate in agency-wide activities.

Each pair is also supported by ongo-

ing monthly contact with agency staff.

These innovations are complemented

by several strategies directed toward

enhancing access to peer support.

The GirlPOWER! program fea-

tures a series of 12 psychoeducational

workshops that are attended by a

group of 10-15 participat-

ing girls (ages 10-13) and

their mentors. During each

workshop, active learn-

ing strategies are used to

help the group explore

topic areas that have im-

portant implications for

healthy development (e.g.,

self-esteem, nutrition and

exercise, romantic relation-

ships, substance use). Each

session has a MatchBuild-

er segment, in which a

volunteer Match role-plays

a challenging interaction

between a hypothetical girl and her

mentor, and the group then discusses

ways to resolve the situation that is

depicted in the role-play. Other activi-

ties for youth-mentor pairs are linked

thematically with workshop content.

Youth and mentors are asked to con-

tinue these activities for a 3-month

period after the workshop series con-

cludes, leading up to a group reunion

at the end of the year. “POWER” is

used as an acronym for five core con-

cepts (Pride, Opportunity, Women-in-

the-Making, Energy and Effort, and

Relationships) that are interwoven

through all program components.

The “Relationships” concept reflects

the program’s focus on the cultivation

of supportive relationships between

girls, their mentors, other adults, and

peers. The joint participation of men-

tors and girls in the sessions gives

girls and mentors an “opening” and

common language to talk about top-

ics that are difficult due to their sen-

sitive or challenging nature. Through

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

this process, the program seeks to

enable mentors to move beyond com-

panionship to providing girls with

guidance and emotional support in

dealing with a wide range of issues.

The activities provide structured op-

portunities for mentors and youth to

talk about workshop topics and begin

to incorporate relevant activities into

their relationships (e.g., regular exer-

cise, healthy eating). There also is a

session early in the program that is

devoted specifically to developing the

Match relationship by having youth

and mentors set goals together and

then plan for how they can support

each other in reaching these goals.

Parents attend a program orienta-

tion and the final workshop in which

girls and their mentors perform a tal-

ent show and graduate from the pro-

gram. Parental involvement is encour-

aged throughout the program by hav-

ing girls bring home an informational

handout after each workshop. The

handouts summarize session activi-

ties and provide parents with tips and

suggestions for how they can support

their daughters’ healthy development

in areas related to the workshop topic.

Throughout the program, both girls

and mentors also are encouraged to

identify other adults in the girls’ so-

cial networks and to invite them to

join in activities where appropriate. In

this way, the youth’s mentor may be

able to work cooperatively with other

important adults in the youth’s life.

Likewise, through connections to the

mentor’s social network, the youth

may be exposed to new positive adult

role models and sources of support.

Several features of the GirlPOW-

ER! program are designed to help

girls establish supportive relationships

with peers. These include the group

setting for sessions in which girls are

able to meet and spend time with

other girls their age. The sessions are

structured to foster positive interac-

tions among girls through activities

such as games in which they compete

as a team against their mentors. The

sessions also allow girls to practice in-

terpersonal skills helpful to healthy re-

lationships with peers. These include,

for example, skills for support-seeking,

dealing with peer pressure, and asser-

tiveness in dating relationships. The

active involvement of mentors in ses-

sions ensures that youth have access

to adult support as they learn these

skills. This involvement provides the

mentor, too, with a valuable opportu-

nity to deepen her understanding of

the issues that influence the quality

of the youth’s peer relationships, en-

hancing her capacity to offer effective

guidance regarding peer-related issues

both in and out of program sessions.

Conclusions

Research indicates that young ado-

lescents who receive social support

from peers and adults are significantly

better equipped to cope with challeng-

es. An imbalance in the direction of

over-reliance on either peers or adult

sources of support places youth at risk

for problems in their emotional and

behavioral adjustment as they transi-

tion into adolescence. There is a need

for interventions and policies that are

designed to ensure that young ado-

lescents benefit from supportive ties

with both peers and adults in equal

measure. The GirlPOWER! program

described in this paper illustrates the

types of innovation to existing models

of practice that may prove successful

for achieving this important goal.

References

DuBois, D. L., Burk-Braxton, C., Sw-

enson, L. P., Tevendale, H. D., Lock-

erd, E. M., & Moran, B. L. (2002).

Getting by with a little help from self

and others: Self-esteem and social

support as resources during early ado-

lescence. Developmental Psychology, 38,

822-839.

DuBois, D. L., Felner, R. D., Brand,

S., & George, G. R. (1999). Profiles

of self-esteem in early adolescence:

Identification and investigation of

adaptive correlates. American Journal

of Community Psychology, 27, 899-932.

DuBois, D. L., Holloway, B. E., Val-

entine, J. C., & Cooper, H. (2002). Ef-

fectiveness of mentoring programs for

youth: A meta-analytic review. Ameri-

can Journal of Community Psychology,

30, 157-197.

DuBois, D. L., & Silverthorn, N.

(2004). Do deviant peer associations

mediate the contributions of self-es-

teem to problem behavior during ear-

ly adolescence? A 2-year longitudinal

study. Journal of Clinical Child and Ado-

lescent Psychology, 33, 382-388.

Rhodes, J. E., Haight, W., & Briggs,

E. (1999). The influence of mentor-

ing on the peer relationships of foster

youth in relative and nonrelative care.

Journal of Research on Adolescence, 9,

185-201.

Rhodes, J. M. (2002). Stand by me:

The risks and rewards of mentoringto-

day’s youth. Cambridge, MA: Harvard

University Press.

Naida Silverthorn is a post-doc-

toral fellow at the Institute for Health

Research and Policy at the University

of Illinois at Chicago.

David DuBois is Associate Profes-

sor in the Division of Community

Health Sciences in the School of Pub-

lic Health at the University of Illinois

at Chicago.

Youth participating in mentoring

programs have demonstrated improvements

in their relationships with peers.

Winter 2006, Vol. 20 No. 1

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

Wraparound is a support

planning process that is fa-

cilitated and team-based. The youth

(or child) and family, natural supports,

and service professionals partner to

develop and implement a strength-

based, culturally competent, and

highly individualized support plan

with the goal of maximizing youth

and family functioning and happi-

ness. Natural supports are individu-

als identified by the youth and family

who participate in the wraparound

process. These are people who know

the youth and family well, who care

about them, and who provide support

without being paid. Natural supports

are the individuals who provide long-

term support to the youth and family,

and who thus permit the wraparound

facilitator and other professionals to

transition out of their intensive service

and support roles over time. The role

of natural supports in wraparound

plan development and implementa-

tion is crucial and central to the pro-

cess, and is perhaps the aspect of the

wraparound that most distinguishes it

from other helping models.

As a wraparound trainer and

coach, I support facilitators as they

learn the craft of wraparound. Wrap-

around facilitators frequently report

that they have significant challenges

building natural supports. Since this

is an essential element of wraparound

practice, facilitators learning the

model need effective coaching sup-

port from supervisors and others who

guide their development targeted to

this area if natural supports are to be

successfully involved on wraparound

teams.

In this article, I will discuss three

specific challenges frequently re-

ported by wraparound facilitators in

building natural supports: identifica-

tion of natural supports, engagement

of natural supports, and recruitment

of surrogate natural supports.

Identiﬁcation of

Natural Supports

I have lost count of the number

of times enthusiastic facilitators who

are learning wraparound have said to

me, “I know natural supports are an

essential element of wraparound, but

there just aren’t any for this family.”

I typically respond by saying, “Let’s

slow down and back up a few steps.”

It is necessary to determine if the fa-

cilitator has established enough trust

with the youth and family for them to

disclose information about the indi-

COMMON PRACTICE CHALLENGES AND PROMISING

COACHING SOLUTIONS

WRAPAROUND AND NATURAL SUPPORTS:

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FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

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viduals in their life from whom they

derive support.

It is important for facilitators to

establish a foundation of trust with

a youth and family before beginning

to identify natural supports. Prema-

ture initiation of the process of iden-

tifying natural supports can result in

superficial responses from the family.

This can lead the facilitator to falsely

conclude that the family does not have

any natural supports. Beginning facil-

itators may need support to strength-

en their youth and family engagement

skills so initial trust is reliably estab-

lished before the natural supports dis-

covery process is begun.

Wraparound facilitators must also

learn to conduct a discovery with the

youth and family that is of sufficient

breadth and depth to reliably iden-

tify current and potential natural sup-

ports. Many skillful facilitators use life

domains as a structure to guide their

natural support discovery efforts. It

helps them ensure that the natural

support discovery process covers all

areas of the youth and family’s lives

where current or potential natural

supports might exist.

Life Domains (see sidebar) are a

tool used to guide the discovery pro-

cess that helps ensure that the discov-

ery is broad enough to identify natural

supports across all areas of life of the

family and youth.

Skillful facilitators must learn strat-

egies to conduct deep discovery in

particular life domain areas. Domains

that need deep discovery include fam-

ily and extended family, spiritual and

faith community, and friends.

For example, to support deep dis-

covery in the family and extended

family life domain, I teach novice

facilitators skills so they can draw

three-generation family trees for each

wraparound family. To teach this skill

to a new facilitator, we draw a fam-

ily tree together using a wraparound

family selected by the facilitator. We

start the tree with the child or youth

that was referred to wraparound. We

next add the immediate family mem-

bers and any other individuals who

live in the household to the tree. Then

we add family members not in the

immediate household. Last we add

maternal and paternal grandparents

as well as aunts, uncles, and cousins

and step-family members not already

identified. I ask the facilitator to label

people on the tree by first name and to

note their whereabouts.

The beginning facilitator often rec-

ognizes that he or she has significant

information gaps about emotionally

significant relationships in the fam-

ily and extended family life domain

as a result of drawing the family tree.

Common information gaps include:

not knowing the names of one or sev-

eral of the individuals who live in the

household, not knowing the name or

whereabouts of the youth’s biological

mother or father, and/or little to no

information about the youth’s grand-

parents and other extended family. I

help the facilitator to understand that

deep discovery of natural supports in

the family and extended family life

domain is not complete until all infor-

mation gaps are filled. Only then can

the facilitator make accurate conclu-

sions with the youth and family about

the presence or absence of natural

supports in this life domain.

Engaging Natural Supports

Novice facilitators frequently tell

me, “The youth and family have

natural supports, but they don’t want

them on the team.” Facilitators learn-

ing wraparound practice sometimes

push prematurely for the involvement

of identified natural supports on the

wraparound team. Experienced fa-

cilitators recognize that taking time

to build a rationale for involving

natural supports on the wraparound

team maximizes the potential for the

successful involvement of these cru-

cial supports. A family is much more

likely to agree with the involvement of

natural supports on their wraparound

team when natural supports are invit-

ed to participate on the team to meet

a specific need that has been identified

by the facilitator and the family.

Here are two typical examples:

1. A mother who agrees that she

is tired, alone, and needs more emo-

tional support enthusiastically agrees

to involve her best friend on the team

when the friend’s initial job on the

team is to provide her with emotional

support during the meetings.

2. A single father recognizes, with

facilitator support, that his adolescent

son would benefit from an adult fe-

male mentor. The father and youth

agree that the father’s sister might help

meet this need. The father is pleased

to have his sister invited to participate

at the next meeting.

Another factor influencing a fami-

ly’s willingness to involve natural sup-

ports on their team is feeling shame.

Novice facilitators sometimes fail to

anticipate feelings of shame and do

not adequately discuss and normalize

these feelings before suggesting natu-

ral support involvement on the fami-

ly’s team. Skillful facilitators actively

discuss feelings of shame as well as

other feelings and fears, address issues

of confidentiality, and define what

sensitive information needs to be

shared with team members in order to

develop a meaningful support plan for

the youth and family. Sensitive atten-

tion to these universal issues prepares

families for the inclusion of natural

supports on their teams.

In the process of discovery of natu-

ral supports, a youth and family may

identify friends, relatives, and other

natural supports who have provided

Family and extended family

Friends

Emotional

Safety

Spiritual and Faith community

Work and ﬁnancial

Residence and neighborhood

Legal

School and education

Medical

Fun

Other

LIFE DOMAINS

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

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reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

support to them in the past but who

do not currently have positive rela-

tionships with the family. The fam-

ily does not then see them as current

sources of support. Novice facilita-

tors often do not invest enough energy

to determine if these previously sup-

portive relationships can be restored.

Experienced facilitators might say to

a youth: “I understand you and Bill

were best friends before the argument,

and that since then, you aren’t talk-

ing anymore. What would it

take for you and him to make

things right?” With needed

support from the facilitator

and others who care, some

potential sources of natural

support can be restored and

then become available to par-

ticipate on the wraparound

team.

Recruiting Surrogate

Natural Supports

Some families are truly

isolated—they have lost their

natural supports. In this cir-

cumstance, the facilitator

must assist the youth and

family to recruit surrogate

natural supports to partici-

pate on the team. Skillful

facilitators master various re-

cruitment strategies, includ-

ing the two that follow.

In the first strategy, the

facilitator, with support from

his or her colleagues and supervisor,

develops a plan targeting community

organizations often referred to as “bro-

kers of natural supports.” The plan

is designed to identify potential sur-

rogate supports and connect them to

youth and adult caregivers who need

them. Community churches, service

clubs, and many other community

organizations have members who are

interested in volunteering their time

in the service of youth and families

who have needs. The community

development plan begins by educat-

ing these broker organizations about

the wraparound process. As relation-

ships with broker organizations are

strengthened, a range of possible roles

for interested volunteers from these

organizations are defined, including

support of youth and families by par-

ticipation on wraparound teams and

one-to-one mentoring of youth and

adult caregivers. Willing volunteers

are then engaged on teams to broaden

the base of support of isolated youth

and families.

The second strategy is strength-

based recruitment of family-specific

surrogate natural supports. This strat-

egy is based on the use of the youth

and family’s strengths to guide highly

individualized recruitment efforts of

surrogate team members. For exam-

ple, a facilitator contacts a colleague’s

mechanic and asks him to meet with

a youth in wraparound based on the

youth’s interest in automotive repair.

The youth and mechanic hit it off.

The mechanic mentors the youth in

automotive repair and becomes a pe-

riodic participant on the wraparound

team.

Strength-based recruitment maxi-

mizes “fit” of surrogates and the youth

and family by matching them on one

or more areas of shared strengths, in-

terests, preferences, and/or culture.

Mutual acceptance between surrogate

supports and youth and families max-

imizes benefits and the establishment

of self-sustaining relationships.

Conclusion

Wraparound is a complex process

whereby youth and families with mul-

tiple life challenges are supported by

a team composed of profes-

sionals and natural supports.

Natural support participa-

tion on the planning team

and assistance implementing

the service and support plan

are essential and unique el-

ements of the wraparound

practice model. Wraparound

facilitators often report prac-

tice challenges that can be-

come barriers to building

effective teams that include

natural supports. Some of

these common practice chal-

lenges were identified and

discussed, and promising

coaching strategies were re-

viewed. The preceding paper

was neither comprehensive

nor authoritative. Nonethe-

less, I hope it causes wrap-

around supervisors, trainers,

and others responsible for

wraparound practice qual-

ity to reflect on their current

coaching activities in this

area of wraparound practice. Further,

I hope such reflection leads to addi-

tional exploration of the role of natu-

ral supports in wraparound, as well as

improved coaching activities designed

to strengthen facilitator effectiveness

in building natural supports.

Greg S. Dalder is Executive Vice

President of Vroon VanDenBerg LLP.

Previous education in social work and

experience in family therapy inform

his current work, which is focused on

wraparound training and the provi-

sion of follow-on practice coaching.

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

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reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

am the mother of a grown son who

had significant behavioral health

and other challenges as a youth. I

am also a wraparound trainer, trainer

of youth and parent mentors, and

an active leader in our local parent

support organization. It is from these

perspectives that I will share my

thoughts about the importance of

natural supports in the wraparound

process.

My adopted son, Jason, presented

many challenges. Some professionals

thought his biological mother’s heroin

and cocaine addiction during preg-

nancy were the cause of his difficult

and sometimes frightening behavior.

He was given numerous diagnoses:

Conduct Disorder, Bipolar Disorder,

PTSD, ADHD, and Oppositional De-

fiant Disorder.

In 1994, when Jason was 14 years

old, he was nearing discharge from

residential treatment. A psychiatrist

who had evaluated Jason told me he

would likely need institutionalization

for most of his life. I rejected this pre-

diction and believed there must be a

way for Jason to come home and stay

in our community.

In the early 1990s, wraparound

was in its initial implementation in

King County, Washington. I was re-

ceiving support from parents involved

in a parent organization in our area.

One of the local leaders and a profes-

sional partnering with the parent or-

ganization suggested that a new sup-

port- and strength-based approach,

wraparound, might be beneficial to

Jason and me, since typical profes-

sional services had not resulted in

sustained improvement in Jason and

our family life. I was given a copy of a

wraparound training manual, which I

read on my own.

I learned that the core of the wrap-

around process was a child and family

team and that the team should include

professional service providers as well

as natural supports—those individu-

als in the life of the youth and family

who knew them best. I learned that

the team’s job was to provide support

and to develop and implement an in-

dividualized and strength-based plan

that addressed priority needs.

As I considered the possibility of

the wraparound process for Jason and

me, I recognized that the prospect of

including natural supports on a team

was a good “fit” with our family cul-

ture. The tradition and culture of our

family emphasizes community, i.e.,

taking care of our own and each other

are prominent values of the tradition.

I was also raised in a Bible-believing

family. Biblical scripture emphasizes

supporting one another uncondition-

ally in the community of faith. Involv-

ing natural supports on our team was

consistent with our values, personal

beliefs, and family culture.

I recognized that the idea of orga-

nizing natural supports to help Jason

and me through the wraparound pro-

cess felt comfortable, safe, and natu-

ral. Who better to provide support

NATURAL SUPPORTS FROM A PARENT PERSPECTIVE

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

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reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

Thank you! This issue was made possible by the assistance of the following people: Stacey Sowders,

Melanie Sage, and Donna Fleming. We couldn’t have done it without you!

than those individuals whom we trust

the most and who know us the best?

Natural supports would be there with

us over the long haul—professionals

turnover and eventually go away—

and natural supports would be more

accessible. I could call a neighbor or

friend at 2 a.m. and know that they’d

be there; not so with Jason’s thera-

pist.

I decided to conduct our own

wraparound process. I convened and

facilitated our own child and family

wraparound team. Our initial team

was composed of Jason’s older brother

and sister, my best friend from work, a

boxing coach and his wife, my parents

over long distance, our case manager,

Jason’s therapist, and a teacher. Later

a neighbor couple joined the team

along with Jason’s friend Peter and his

mother. All of these people already

knew us, and knew our family’s sto-

ry; each person brought an ability, a

strength to match a specific need. The

boxing coach, for example, used his

skills to teach Jason how to regulate

his emotions, and a neighbor, who had

gotten to know Jason through shared

interests in REI (A Seattle-based out-

door equipment company), could de-

fuse his rages by simply coming to the

door when I called for help. Jason’s

older brother—his BIG older broth-

er, all of 6’3” and 240 pounds—also

helped interrupt disruptive behavior,

while Jason’s older sister and her hus-

band provided respite care.

Though there were many ups and

downs, our team showed us persistent

commitment, gave us much needed

emotional and tangible support, and

came up with many creative ideas we

would have never thought of alone.

One creative idea came from our

neighbors. After we’d agreed that

they would come over to my house

to help calm Jason, we needed a reli-

able, quiet way to signal that help was

needed. They found a solution: when

we needed help, I would flick on

Christmas lights in our kitchen win-

dows (a porch light wouldn’t serve the

same purpose, and our porch was not

visible from their home in any case).

Surprising emotional support came

from an extended family member who

organized an impromptu barbeque for

me to relieve the unrelenting tension

from one of Jason’s frequent ‘runs.’

This simple act of celebrating as fami-

ly and friends, rather than being

consumed by worry and caught

up in the ‘drama’ of my son’s

behavior, gave me a completely

new perspective.

In the years since as a wrap-

around trainer, trainer of youth

and parent mentors, parent

partner, and as an active leader

in our local parent support or-

ganization, I have been involved

with many other youth and

their families who were facing

daunting challenges. My expe-

riences with these families have

validated over and over again

the wisdom and importance of

helping families to identify, mo-

bilize and build sources of natu-

ral support. Natural support is

suitable for the culture of most

families as well as essential to

achieving and sustaining functional

outcomes.

Postscript

Jason is 25 now. His life is not per-

fect. He lives on his own. He lives in

the community and we continue to

have an important relationship with

each other.

Jeanette Barnes is a Family

Treatment Court Specialist with King

County Superior Court, a Wraparound

Trainer, Parent and Youth Mentor

Trainer, and a Parent Organization

Leader for A Village Project.

This article was written by Greg S. Dalder

and Lyn Gordon, based on an interview

with Jeanette Barnes.

Winter 2006, Vol. 20 No. 1

Regional Research Institute for Human Services, Portland State University.

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reproduce articles at no charge, please contact the publications coordinator at 503.725.4175; fax 503.725.4180 or email rtcpubs@pdx.edu

FOCAL POiNT Research, Policy, and Practice in Children’s Mental Health

FOCAL POiNT

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SELECT RTC PUBLICATIONS CD

 QUALITY AND INDIVIDUALIZATION

IN WRAPAROUND TEAM PLANNING.

2005. Journal of Child & Family Stud-

ies, 14(2).

 TRANSFORMING MENTAL HEALTH CARE

FOR CHILDREN AND THEIR FAMILIES.

2005. American Psychologist, 60(6).

 PRESERVING FAMILY BONDS: EXAM-

INING PARENT PERSPECTIVES IN THE

LIGHT OF PRACTICE STANDARDS FOR

OUT-OF-HOME TREATMENT. 2005.

American Journal of Orthopsychiatry,

75(4).

 PRACTICE AND PROCESS IN WRAP-

AROUND TEAMWORK. 2004. Journal

of Emotional and Behavioral Disorders,

12(3).

 FAMILY CAREGIVERS’ PERCEPTIONS

OF BARRIERS TO AND SUPPORTS OF

PARTICIPATION IN THEIR CHILDREN’S

OUT-OF-HOME TREATMENT. 2003. Psy-

chiatric Services, 54(11).

 RESEARCH IN THE SERVICE OF POLICY

CHANGE: THE “CUSTODY PROBLEM”.

2003. Journal of Emotional and Behav-

ioral Disorders, 11(1).

BUILDING ON FAMILY STRENGTHS CONFERENCE PROCEEDINGS

(includes presentation summaries)

 2001 Keynote, Carol Spigner. 

 2000 Keynote, Nirbhay Singh. 

 1999 Keynote, Beth Harry. 

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Our most recent and popular issues:

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2003, 17(2), Fall.

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COMPETENCE. 2002, 16(2), Fall.

 BUILDING ON STRENGTHS IN COMMUNITY

SETTINGS. 2002, 16(1), Spring.

 TRANSITIONS FOR CHILDREN WITH

EMOTIONAL AND BEHAVIORAL CHALLENGES.

2001, 15(1), Spring.

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 MANAGEMENT STRATEGIES FOR POSITIVE

MENTAL HEALTH OUTCOMES: WHAT EARLY

CHILDHOOD ADMINISTRATORS NEED TO

KNOW. 2004. 

 FAMILIES IN THE WORLD OF EVALUATION:

THE EVALUATION OF THE NATIONAL FEDERA-

TION OF FAMILIES FOR CHILDREN’S MENTAL

HEALTH COURSE I, “HOW TO UNDERSTAND

EVALUATION.” 2003. 

 IMPLEMENTING HIGH-QUALITY COLLABORA-

TIVE INDIVIDUALIZED SERVICE/SUPPORT

PLANNING: NECESSARY CONDITIONS. 2003.



 SETTING THE PACE: MODEL INCLUSIVE

CHILD CARE CENTERS SERVING FAMILIES

OF CHILDREN WITH EMOTIONAL OR BEHAV-

IORAL CHALLENGES. EXECUTIVE SUMMARY.

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START: SELECTED NATIONAL FINDINGS.

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 INCLUSION OF CHILDREN WITH EMOTION-

AL OR BEHAVIORAL CHALLENGES IN CHILD

CARE SETTINGS: AN OBSERVATIONAL STUDY.

2002. 

ResearchGate has not been able to resolve any citations for this publication.

Building a Model of Family Caregiving for Children with Emotional Disorders

Article

Full-text available

Sep 1997
J EMOT BEHAV DISORD

In this article we describe the results of an ongoing effort to better understand the caregiving process in families of children with severe emotional problems. We make two assumptions. First, we assume that these families are essentially like other families but are faced with a special challenge in raising and caring for their special children while at the same time performing the multiple tasks and demands faced by all families. Second, we assume that public policy and programs must be supportive of the care of these children in their own homes and communities whenever possible. The purpose of this article is to present a model of family caregiving that draws broadly from available theory and empirical literature in multiple fields and to subject this model to empirical testing. We use structural equation modeling with latent variables to estimate an empirical model based on the theoretical model. Results of the model testing point to the importance of the child's external problem behaviors and the family's socioeconomic status and coping strategies as determinants of caregiver stress. Other findings highlight difficulties in measuring and modeling the complex mediating process, which includes formal and informal supports, perceptions, and coping behaviors. The use of structural equation modeling can benefit our efforts to support families by making explicit our theories about the important dimensions of this process and the relationship between these dimensions, which can then be subjected to measurement and validation.

Mentoring School-Age Children: Relationship Development in Community-Based and School-Based Programs

Article

Full-text available

Jan 2000

Social Support Measurement and Intervention: A Guide for Health and Social Scientists

Article

Oct 2000

Surgery and pharmaceuticals are not the only effective procedures we have to improve our health. The natural human tendency to care for fellow humans, to support them with social networks, has proven to be a powerful treatment as well. As a result, the areas of application for social support intervention have expanded dramatically during the past 20 years. The title is divided into four sections. The first provides some historical context as well as a conceptual overview of how social support might influence mental and physical health. The second discusses techniques for measuring social networks and support, and the third addresses the design of different types of support interventions. The final section presents some general comments on the volume and its implications for social support research and intervention. This resource is meant to aid researchers in understanding the conceptual criteria on which measurement and intervention decisions should be made when studying the relations between social support and health.

Stand by Me: The Risks and Rewards of Mentoring Today’s Youth

Book

Jun 2009

Jean Rhodes