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   Psychiatric Quarterly, Vol. 77, No. 2, Summer 2006 (  C   2006) DOI: 10.1007/s11126-006-9001-3  A NATIONAL SURVEY OF STATE MENTALHEALTH AUTHORITY PROGRAMS ANDPOLICIES FOR CLIENTS WHO AREPARENTS: A DECADE LATER Kathleen Biebel, Ph.D., Joanne Nicholson, Ph.D.,Jeffrey Geller, M.D., M.P.H., and William Fisher, Ph.D.  Published online: 14 June 2006 This study presents a survey of State Mental Health Authorities’ (SMHA) pro-grams and policies addressing the needs of adult clients in their role as parent.Six program and policy areas (parent status identification, parent-focused res-idential programs, parent functioning assessment, outpatient services for par-ents, policies for hospitalized parents, and policies for hospitalized pregnantwomen) are examined. Results of the most recent 1999 survey are comparedwith results from a similar 1990 survey. This comparison reveals that the Kathleen Biebel, Ph.D., is Research Assistant Professor, Department of Psychia-try, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester,Massachusetts 01655.Joanne Nicholson, Ph.D., is Professor of Psychiatry and Family Medicine, Universityof Massachusetts Medical School.Jeffrey Geller, M.D., M.P.H., is Professor of Psychiatry, University of MassachusettsMedical School.WilliamFisher,Ph.D., isProfessorofPsychiatry, Universityof MassachusettsMedicalSchool. Address correspondence to Kathleen Biebel, Ph.D., is Research Assistant Professor,Center for Mental Health Services Research, Department of Psychiatry, University of MassachusettsMedicalSchool,55LakeAvenueNorth, Worcester,Massachusetts01655;e-mail: 0033-2720/06/0600-0119/0  C   2006 Springer Science+Business Media, Inc.  120 PSYCHIATRIC QUARTERLY  majority of SMHAs continue to overlook adult clients in their parenting role,and few SMHA programs and policies address issues of parenting. KEY WORDS:  state mental health authority; parents; mental health policy. OBJECTIVE The majority of adults in the United States who meet criteria for men-tal illness during the course of their lifetime are parents (1,2). Families living with parental mental illness face numerous challenges includ-ing increased risk of custody loss, children at risk for psychologicalproblems, and financial instability (1). Many parents with mental ill-ness say that not being able to parent their children compromises theirwell-being, and impedes their progress towards recovery (3,4). In order forparentswithmentalillnesstohaveoptimalcommunityfunctioning,their role as parent must be considered.In 1993, Nicholson and colleagues published the first national sur- vey of State Mental Health Authority (SMHA) Commissioners regard-ing programs and policies for adult clients in their role as parent (5). Nicholson et al. found that SMHA clients’ status as parents was notroutinely identified, and no policies existed to provide contact betweenhospitalized mothers and their children (5). Neglect of the parenting  role can increase barriers to services for families, may result in missedopportunitiesforpromotingrehabilitationandrecoveryofadultclients,and may jeopardize their reintegration into community life. The cur-rent survey study examines 1999 SMHAs’ programs and policies toreplicate the earlier study of SMHAs regarding adult clients who areparents, and to compare findings. METHODS In February 1999 a survey was mailed to the Commissioner or Directorof mental health of each state and the District of Columbia request-ing information about SMHA programs and policies for adults withmental illness in their role as parents. The 1999 survey was based onthe 1990 survey, developed and administered by the authors, whichrequested information about women who received services from publicsectormentalhealthprovidersandwhohadpreschoolagechildren.The  KATHLEEN BIEBEL ET AL. 121 1999 survey included several new questions and expanded the scope of the 1990 survey. The 1999 survey was inclusive of parents of childrenof any age, and asked about all parents with mental illness, i.e., did notfocus exclusively on mothers.Multiple questions were collapsed into six areas that most closelyresembled the six questions from the 1990 survey. 1999 SMHA sur- vey questions were designed to obtain information about SMHAs’policies and programs provided to clients who are parents withmental illness. Survey respondents were asked the following ques-tions: (1) Are all adult clients formally identified as parents by the SMHA? (2) [Does the SMHA] have Community Residential ser-  vices/programs for adult SMHA clients who are parents? (3) Aremale/female SMHA clients assessed regarding their functioning asparents? (4) [Does the SMHA] have Community/Rehabilitation, Em-ployment/Vocational, Clubhouse, Day Treatment, or Outpatient ser- vices/programs for adult SMHA clients who are parents? (5) [Does the SMHA] have specific policies or practice guidelines in acute andcontinuing inpatient settings re: adult SMHA clients who are par-ents? (6) [Does the SMHA] have specific policies or practice guide-lines in acute and continuing inpatient settings re: adult SMHA clients who are pregnant? Data from the survey were categorical, withthe majority of questions having “Yes, No, or Don’t Know” responseoptions.The 1999 survey was reviewed by experts in parenting, mentalhealth and policy, and SMHA administrators for relevance, clarity,and ease of completion prior to its distribution. Study methods werereviewed by the University of Massachusetts Medical School Institu-tional Review Board. Participation in the 1999 survey was 100 percent,with either the SMHA Commissioner or Director of adult mentalhealth services completing the survey. All surveys were returnedwithin eight months. Responses were analyzed using descriptivestatistics. Data were internally cross-checked for consistency andanalyzed for links between response patterns and respondents. RESULTS States with SMHAs providing affirmative responses to the questionsregarding programs and policies for parents with mental illness re-ceiving SMHA services are listed in Table 1, along with responses to comparable items from the 1990 survey.  1 2 2 P  S Y  C HI  A T  RI   C   Q UA  RT E RL Y  Table 1Comparison of SMHAs’ Programs and Policies for Parents with Mental Illness in 1990 and 1999 1990 1999Policy or program State Policy or program StateRoutine collectionof data onwhetherpatients haveyoung children Arkansas, Arizona, Delaware,Kentucky, Maryland, Michigan,Nebraska, Oregon, Pennsylvania,South Dakota, Tennessee, Vermont, Virginia, Washington,Wisconsin, Wyoming (  N  = 16)Formal identification of adult clients asparents by the SMHA  Alabama, Arizona, Connecticut,District of Columbia, Idaho,Illinois, Massachusetts, Nevada,New Jersey, South Carolina,Tennessee, Wisconsin (  N  = 12)ResidentialprogramsCalifornia, Connecticut, Florida,Louisiana (  N  = 4)Community Residentialprograms for parentsDistrict of Columbia, Kentucky,Minnesota, Missouri, Nevada,New York, Ohio, South Dakota(  N  = 8)Formal assessmentof parenting skills Arkansas, California, Connecticut,Delaware, District of Columbia,Indiana, Kentucky, Maryland,Mississippi, Missouri, Montana,Nebraska, Nevada, New Mexico,New York, North Carolina, Ohio,Oregon, Rhode Island, SouthDakota, Tennessee, Virginia,Washington (  N  = 23) Assessment of parentfunctioning  Arkansas, California, District of Columbia, Kentucky, Louisiana,Minnesota, North Dakota,Oregon, South Dakota, Utah, Vermont (  N  = 11)  KA T HL EE NBI  EBEL ET A L  .1 2  3  Table 1Continued 1990 1999Policy or program State Policy or program StateOutpatientservices focusedon parenting skills Alabama, Arkansas, Colorado,Connecticut, Delaware, District of Columbia, Florida, Hawaii,Indiana, Kentucky, Maryland,Minnesota, Mississippi, Missouri,Montana, Nebraska, Nevada,New Mexico, New York, NorthCarolina, Ohio, Oregon, RhodeIsland, South Dakota, Tennessee, Virginia, Wisconsin, Wyoming (  N  = 28)Community/ Rehabilitation,Employment/  Vocational,Clubhouse, DayTreatment orOutpatient servicesfor parentsDistrict of Columbia, Kentucky,Louisiana, Massachusetts,Missouri, Nevada, New York,Ohio, Rhode Island, SouthCarolina, South Dakota, Utah(  N  = 12)Policy thataddressescontact betweenhospitalizedmothers andtheir childrenNone Policy for hospitalizedparentsIllinois, Massachusetts (  N  = 2)Policy thataddresses care of hospitalizedpregnant women Alabama, California, Connecticut,Florida, Iowa, Kentucky,Maryland, Nebraska, New Jersey, Virginia (  N  = 10)Policy for hospitalizedpregnant women Arizona, California, District of Columbia, Massachusetts,Nevada, Oklahoma,Pennsylvania, Rhode Island,South Carolina, Missouri (  N  = 10)
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