Bertram J. Cohler and Judith S. Mustek (eds) INTERVENTION AMONG PSYCH1ATRICALLY IMPAIRED PARENTS AND THEIR YOUNG CHILDREN San Francisco, Jossey-Bass, 1984, 129 pp. $8.95
This compilation of five studies is the 24th publication in a series entitled "New Directions for Mental Health Services" under the editorship of H. Richard Lamb. Two other publications in the series suggest by their titles that they would be of interest to the pediatrician: "Adolescence: Perspectives on Psychotherapy" and "Patterns of Adolescent Self-image."
The five studies under consideration here represent the experience at centers which serve the ambulatory mentally ill or emotionally compromised parent. The problem of the impaired young parent has been magnified in the past dozen or so years, owing to the states' deinstitutionalization programs for the care of the mentally ill. With the reduction in hospital beds and abbreviation of hospital stay for these patients, local communities have been challenged to provide ambulatory care, hence the impetus for finding new ways of providing mental health services.
The studies reported here have been conducted almost entirely by social workers and psychologists with little or no participation from pediatricians or psychiatrists. This is not said to diminish in any way the significance of the work, but merely to indicate that the experimental design, in those chapters which are based on an investigative model, as well as the specifics of the programs and the general thrust are directed more at social agencies and psychiatric outpatient facilities than at pediatric clinics or pediatric practitioners.
Nevertheless, a common theme that unifies all of these multi-authored chapters contains an important message for pediatricians, namely that offspring of mentally ill parents are at risk, and timely, appropriate intervention can minimize that risk. Among the risk factors for the offspring are: disruption of mother-infant attachment, generally delayed or skewed development, emotional or conduct disturbances, and impaired cognitive development. Intervention measures generally were aimed at improving parenting skills, facilitating emotional and cognitive development of the child, and prevention of parent hospitalization. Some of the interventions were home-based, with periodic home visits by a nurse or social worker or psychologist to provide continuing guidance and modeling, and give the mother both competence and confidence in her mothering efforts. Another intervention model was clinic-based, offering a variety of services and professionals to teach, treat, evaluate, and provide for practical needs. Outcome studies based on parents' evaluations indicated that the clinic model was superior to home visiting in that it provided the mother with group learning, group support, therapy, and a nursery to relieve her of the unremitting stress of caring for a child alone at home, all within a single setting. Outcome studies that evaluated child's social skills, cognitive development, and school adjustment were less clearcut. Factors such as age at intervention, teachers' ratings vs. study group's ratings, and mother's education tended to confound the results. One particularly interesting and important finding was that child improvement and mother satisfaction occurred without a concomitant improvement in mother's psychopathology.
In summary, there is a wealth of interesting detail to be mined from these studies, although the material is more useful for researchers, program designers, social agencies, and educators than for pediatricians. The relevant message for the pediatrician is twofold: children of mentally impaired parents are at risk, and early intervention with services to both parent and child minimize the risk.