What can be an issue with taking care of children?

In recent decades, dramatic changes have taken place in families in the US due to an increased number of divorces, families with one parent and families with stepparents.

Working mothers and childcare

Nowadays, with women having more and more jobs outside of the household, children are more often cared for by others than the mother, such as by relatives or at a day-care centre. The effect of this differs based on the quality of care, the amount of care and certain family characteristics. High quality care is positively related to the cognitive, social and language development of children who go to a day-care centre from an early age. The research findings regarding the effects of the amount of care are inconsistent. In general, the amount of care seems to be negatively related to the child's development. With regard to the interaction between childcare and family characteristics, it appears that children from low-income families benefit from care at a day-care. This means that care by others can serve as a protective factor for children from families with a low socio-economic status. It is also important that a good relationship between parents and child remains.

From the age of 9 to 12, an increasing number of children will start taking care of themselves. The effects of self-care depend on the amount of time self-care, the level of development of the child, family factors, neighbourhood characteristics and social support. Participation in after-school programs often has a positive effect on the social and academic behaviour of children.

Adoption

The number of adoptions has risen sharply in recent decades. Adopted children have relatively more issues with psychological problems. This is especially the case if children have were adopted at an older age or because they have been exposed to negative conditions such as poor prenatal care, drug addiction or care in an orphanage.

A study has made a distinction between two types of peers: peers from the past (peers or brothers or sisters from the institution from which the child was adopted) and current peers (peers in the current situation). The following conclusions can be drawn from this study:

• Adopted children have a higher IQ and do better at school compared to their peers from the past. Adopted children, however, have more often reported learning difficulties and use special education more often than current peers.
• Adopted children are more securely attached to their adoptive parents than their peers from the past. However, compared to their current peers, they are less securely attached.
• Regarding self-confidence, there are no differences between adopted children and current peers.
• Adopted children exhibit more psychological problems than their current peers.

In general, adoption appears to have a positive effect on children because they 'catch up' with peers from the past in certain areas. In addition, most adopted children function normally intellectually and psychosocial, although there is a small to moderate chance of attachment and behavioural problems.

However, there are also factors that increase the chance of psychological problems:

• Age of adoption: Children who are adopted late have a higher risk.
• Gender: Adopted boys have a higher risk of psychological problems than adopted girls.
• Pre-option factors such as neglect, abuse, prenatal drug exposure and institutional care.

Foster families

Sometimes a child's biological parents are unable to care for the child. The government can then choose to have the child grow up in a foster home, with the ultimate goal of having the child return to the biological family. Although this can have advantages, many children go from foster home to foster home. To improve this situation, the Adoption and Safe Family Act (ASFA) has been adopted in America . This law has attempted to bring about two improvements.

Firstly, foster care treatment programs have been developed because foster children have a high risk of developing psychological problems. The purpose of these programs is to prepare foster parents for the needs of the child.

In addition, the ASFA tries to ensure that foster children have a permanent foster family. Within a certain time the child must return to the biological family, be adopted, or be permanently placed in a foster home. Foster children are regularly adopted by family members. The disadvantages of this are that these family members are often older, have no partner and have a lower income. However, it also has several benefits such as less disturbed child-family relationships and better outcomes for the child.

What is the importance of mental health care?

Research shows that two thirds to three quarters of young people with a diagnosed disorder do not receive psychological help. This is especially true for young people from low-income families or from an ethnic minority. One aspect of the problem is the fact that it is difficult to get mental health care in the US. Equal distribution of financial support between mental health institutions and other health institutions is called mental health parity .

Other aspects of the problem include stigmas, attitudes toward mental healthcare, the integration of primary healthcare services and other community settings such as shelters, the need for preventive care and early intervention, and attention to the cultural context. In addition, many families, especially in rural areas and with an ethnic minority background, find it difficult to access mental health services. Today, services are provided in various settings, such as mental health clinics, residential institutions, psychiatric hospitals, private practices and schools. It is suggested that the emphasis should be on offering services in communal settings, often used by young people and their families. Schools can play an important role in this.

In addition, there are concerns about the fragmentation of mental health services. Mental health care must be better coordinated. This can be done in various ways, for example by accommodating multiple institutions under one roof, by forming a group with people who represent different institutions and by means of multisystemic therapy.

Another problem concerns the limited use of available services. Help seeking behaviour is related to various factors. White families from the higher classes, for example, seek help from institutions faster. Ethnic minority families seek help from the community rather than seeking professional help. If they do, they often stop treatment early. Technological improvements such as mobile communication, virtual reality and communication via the Internet can help to improve access to and use of mental health services.

How is the global society interrelated?

Poverty and health in developing countries

Poverty is a major problem in developing countries and has negative effects in various areas of well-being. Young people can benefit from health programs in areas such as nutrition, prenatal care and vaccination. Relatively little attention is paid to psychological and behavioural problems in developing countries. This is partly the result of a focus on fatal diseases. In addition, the need for treatment is less recognized and there is a stigma about mental disorders.

War situations

Growing up in a war situation seriously influences the development of a child. Some children have witnessed ethnic cleansing, live in chronic war situations or have been abducted or otherwise become part of the war. In addition, many children stay in refugee camps or have fled to other countries. In addition to direct traumatic experiences, these situations are often characterized by uncertainty, separation from family members, loss of the community, little food, a lack of day-care, and so on. A large number of children have also been trained as child soldiers.

It is difficult to research the development of children exposed to war situations. Data is often collected on the basis of people who have fled or groups of immigrants. It is not clear what percent of the children who have experienced a war suffer from psychopathology. PTSD, depression, anxiety, sleeping problems, behavioural problems and physical complaints are often present. Psychological problems can be long-term in nature, but they can also decrease over time. There are various risk factors related to the development of disorders, such as the degree of exposure to traumatic events, a lack of information about missing family members, an inability to respond to new situations, separation from the family, poor family cohesion, psychological problems in the family, little social support and stress after a migration.

Research findings regarding the influence of the developmental timing of exposure to war-related events are inconsistent. On the one hand, older children and adolescents are more exposed to traumatic events, which can have a negative influence on the developmental task of forming a secure identity and good social relationships with a relationship of trust. On the other hand, the cognitive development and coping ability of older children offers protection. There is evidence of gender differences in war-related experiences. Girls have a higher risk of sexual trauma, such as rape and STDs. Boys are more exposed to non-sexual violence and can be involved as (forced) perpetrators of violence.

Despite the risks of war-related experiences, many young people are resilient. A number of factors contribute to this resilience, including child characteristics (e.g. coping skills and intelligence), religious ideas and practices, attachment relationships, the mental health of the parent or caregiver, characteristics of childcare institutions and schools, cultural ideas about the meaning of war-related experiences and cultural ideas and practices related to mental health.

Attempts are being made to prevent or treat the negative effects of war-related disorders. The programs vary from the problems and the situation, for example whether the child lives in a war zone or refugee camp. Three principles of interventions with refugee families are recognized worldwide:

• It is important that practitioners are culturally competent.
• Evidence-based practices should be (where possible) used.
• Interventions must be comprehensive, because families can have economic, social and psychological problems.

The treatment of psychological problems can take various forms, such as group therapy, family interventions and school programs. A three-factor model has been designed that can be used to treat specific war-related symptoms. This model comprises three treatment phases:

• It is necessary to give the child the feeling that he or she is safe.
• Treating specific problems such as PTSD or depression.
• The focus is on building a future. Both practical plans and ambitions for the future must be discussed.

The model recognizes that sometimes it is necessary to move back and forth between the steps.

Adapting to diversity is becoming increasingly important in this changing and "decreasing" world.