Attributions of Responsibility for Children's Mental Health Problems: Parents and Professionals at Odds

Antcrican /ourna/ ofOrthops,yrhratry, 71(4), Octoher 2001 0 2001 American Orthopsychiatric Association, Inc.

Attributions of Responsibility for Children’s Mental Health Problems: Parents and Professionals at Odds

Kathleen J. Pottick, Ph.D., and Diane M. Davis, B.A.

Sun)eys of 102 mothers of inner-city youths with mental health problems and their clinicians examined discrepancies in mothers’ and professionals’ causal and solution attributions for the children’s problems. Greater causal responsibility was attributed to mothers by professionals than by mothers, while they agreed on the children’s responsibility. They disagreed about their respective solution responsibilities, though agreeing that causally responsible children should help with solutions. Mothers considered many more community resources for solutions than did professionals. Implications for improvement of seniices to urban children are discussed.

major premise of effective clinical practice is agreement between professionals A and clients about the nature of the client’s

problems, their causes, and strategies for their amelioration. However, expert and lay opinions about mental health problems are not necessarily consistent (Sonuga-Barke & Balding, 1993) and, under some circumstances, may reveal substantial discrepancies (Furnham, Wardley, & Lillie, 1992).

There is convincing evidence that professionals’ formulations are more likely to emphasize personal over environmental attributions. For example, Ro- sen and Livne (1992) compared the judgments of professional social workers to those of a six- member panel (expert, experienced social workers from academia and social agencies) after both groups had been presented with the same written case summary. They found that the professional group was more likely to describe the client’s problem in personal than environmental terms. In an- other study. Rosen (I 993) compared professionals’

formulations of clients’ problems to their reports of how clients presented their problems. They found that professionals’ formulations were more likely than were the clients’ to emphasize personal attributions. It is possible that mismatches between clients and professionals represent bias on the part of the professionals. However, it has been argued (Kirk, Wakefield, Hsieh, & Pottick, 1999) that clients’ attributions may be more environmentally oriented because of a general psychological ten- dency to explain one’s own behavior on the basis of situational factors. This is consistent with a large body of social psychological literature suggesting that “actors” are more likely to attribute failure to environmental causes, while “observers” tend to attribute it to personal causes. Thus, systematic bi- ases may occur in both directions.

Agreement on the cause of a problem may be important to productive service delivery and use. For example, some studies have shown that individuals who attribute symptoms to personal causes

Rasrd otr a paper prrsrtited at tlir 2000 arirural nieefirig oftlie Courrril or1 Social Work Educatiori, NCTJ York. Resrarcli TOUS supported r r i pnrt by grnritsfroni the Nntiorial Iristrtrtte of Meiital Healtlr (#R07 M H 39195-01 arid #R07 MH 4291 7-02) nrrd Rrttgrrs Uittrtersify Sclrool of Social Work. Arrfliors are at: lristrfute for Healfl i Care Polin] arid Aging Resrarrli (Potfirk, Dunis), arid Scliool of S o d Work (Potfirk), Rirtgrrs Uriiurrsity, N n u Brurinuirk, N./.

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more likely to make referrals to mental health services than are those who do not (Robbins, 1981). There is also evidence that attributions to internal causation influence treatment choice (Batson, 1975; Rosen. 1993). Moreover, some researchers found that clinicians’ theoretical orientation had an impact on causal attribution (McCovern, Newman, & Kopici, 1986): psychodynamic adherents assigned lower levels of patient responsibility for both cause and solution of problems than did adherents ofcognitive-behavioral, family systems, or eclectic approaches.

While attributions of causal responsibility have received significant attention, little research has explored attributions of responsibility for solutions. In a seminal theoretical piece, Brickman and colleagues ( I 982) suggested that professionals and lay persons alike attribute failure in mental health functioning to either internal (self) or external (not-self) causes, and that they also make attributions about who should be responsible for solving problems. Thus, individuals may often feel causal responsibility for a problem, but believe that others are responsible for solving it. Brickman and colleagues described this model of helping and coping as “enlightenment,” because individuals view themselves as weak, and in need of outside sources of enlightenment about better ways of being. Three other models of helping and coping can be identified: the moral model (self-cause, self- solution); the medical model (not self-cause, not self-solution); and compensatory (not self-cause, self-solution).

Brickman et al. suggested that these different perspectives on causation and solution responsibilities have clinical significance, especially in the early phases of the help-seeking effort, when di- vergent reference points may increase the potential for misunderstandings and disagreements. They also theorized that the moral model of helping and coping requires that individuals be properly motivated to solve their problems; the medical model requires that that they receive treatment; the compensatory model requires that they possess power; and the enlightenment model requires that they possess discipline. All four models assume that individuals lack resources to solve their own problems. and that they need helpers to provide the needed motivation. treatment, power, or discipline, respectively. Much of the research generated by adherents of Brickman’s theory has focused on individual help-seekers and professionals (Cronen-

wett & Brickman, 1983; Klienke & Kune, 1998; Neighbors, Musick, & Williams, 1998; Zevon, Ku- ruza, & Brickman, 1982).

Although the theoretical literature addresses the possible differences in perspectives among three parties in viewing causation (Martin. 1983), only one published study seems to have focused on both causal and solution attributions from the three perspectives of parents, professionals. and children. In a vignette-based study of 200 parents, Phares, Ehrbar, and Lum (IY96) found that parents attributed greater responsibility to teachers for causing and solving their children’s internalizing problems, and greater responsibility to their children for causing and solving externalizing problems. However, the study merged the separate scores on responsibility for causation and solution to create a total responsibility measure, so that distribution of cause and solution responsibilities among the three parties cannot be discerned.

Attribution theory and the research it has generated on actor-observer differences have not previ- ously been examined in a situation where an individual is both an actor and an observer of a third party. When a parent seeks help for a child from a professional, however, this situation emerges. From the professional’s perspective, the parent is both actor and observer; from the parent’s perspective, the parent is observer only.

Using attribution theory as a reference point, the hypothesis-driven study reported here investigated causal and solution attributions by parents and professionals in reference to the problems of adolescents using mental health services. The goal was to understand the sources of agreement and disagreement about the causes of the problems and the responsibility for their solution. Unlike previous research, it a) separated attribution of responsibility for causes from attributions of responsibility for solutions; b) surveyed clients and professionals in practice (thus increasing the possibility of valid results); and c) examined solution attributions.

Because the study utilized identical, Likert-type scale measures of multiple causes and solutions for both parents and professionals regarding the same child, it could compare the likelihood of a particular choice of solution, while holding the cause con- stant (risk ratio analysis). Thus, the relative risk of a solution, given the same cause, can be compared between parents and professionals. The use of relative risk ratio analysis has direct implications for delivery of services to minority, inner-city fami-

428 lies, and may yield clinically significant recommendations for practice.

Hypotheses Based on attribution theory and the research Iit-

erature, four hypotheses were proposed, as fol- lows.

1. Mothers, as actors, are likely to assume less causal responsibility than is attributed to them by professionals, as observers.

2. Mothers and professionals, as observers, are likely to agree on the level of causal responsibility borne by the child.

3. When mothers and professionals attribute a lot of causal responsibility to the child for the problem, they are likely to agree that the child has a primary role in solving it; i.e., mothers and professionals are likely to endorse a moral model of helping, 1. When mothers and professionals attribute a

lot of causal responsibility to the mother for the child’s problem, they are likely to disagree about the mother’s role in solving it. Professionals are likely to endorse a moral model of helping, i.e. assign the mother a greater role in solving the problem. Mothers are more likely to endorse an enlightenment model, i.e., assign a greater role in solving the problem to others.

METHOD Data Source

Analyses are based on a study (Lerman & Poi- tick, with Jagannathan, 1995) of a county-wide mental health service system in the Newark, New Jersey, area from 1986 to 1989. Hour-long, struc- tured telephone interviews were conducted with I26 parents or other caregivers who accompanied their adolescent child with mental health problems to one of 13 social agencies. The interviews were conducted within two weeks of intake.

A search of the literature has revealed only these data as the source of identical. theoretically-driven measures of attribution of both cause and solution from the perspectives of both parents and clinicians about such adolescents. Thus, although they are more than ten years old, they remain the most recent data available for rigorous testing of the study hypotheses.

Sample To ensure consistency in actors and observers,

only mothers-biological, step, foster, or adop-

tive-were selected from the 126 caregivers inter- viewed. This excluded I7 cases whose care,’ (livers were aunts, sisters. and grandmothers ( N = 7 ) or fathers. step-fathers. and brothers-in-law (hi= 10). A matched professional interview could not be obtained for seven of the remaining 100 cases. and these were also eliminated. The final analytic sample of caregivers thus consisted of I02 mothers.

Of the professional sample, composed of 38 clinicians who worked with the parent sample, 64% were women and 36% men: their average age was about 39 years (range=25-53). More than half were minorities: black (43.2%). Hispanic (8. I YO). and Asian (2.7%); the rest were white (45.90/). Over two-thirds (67.6%) had graduate degrees. 13.5% some postbachelor’s-level education. 16.2% bachelor degrees. and 2.7’10 some college education. Of those with graduate degrees, 529.0 were in social work or counseling, or in clinical or educational psychology; 40% were in marriage and family specializations; and 8% were from other disciplines. Thus, the professional sample was dominated by minority clinicians from a vari- ety of educational backgrounds and, as is tradi- tional in urban mental health facilities, it contained a number of paraprofessionals.

Analyses based on child’s age, gender. number of problems mentioned, race. zip code, and referral source revealed few differences between the 126 responding caregivers and those who did not re- spond. Further details can be obtained elsewhere (Lerman & Pottick, 1988; Pottick & Lermun, 1991).

Measures A questionnaire (Lerman et ul., 1995) solicited

information about a range of children’s problems, and then used a funnel technique to focus respondents’ answers on the main problem with which they were concerned. The interview protocol contained identical questions for parents and professionals about responsibility for causing the problem and for finding solutions to it: “Considering everything you know about what caused X’s main problem to get started or get worse, how responsible would you say [each of] the following people are-a lot, some, a little, or not at all?” The response items to this question included the adolescent, a friend of the youth, the mother, father, and a brother or sister. Respondents were then asked: “Besides the reasons we have been talking about, some people think that other things could play a part in causing youth problems or making them

Pottick & Davis 42 9

worse. How responsible would you say the following are for causing X’s problem-a lot, some, a little, or not at all?’ Response items included: bad health, heredity, TV, movies, newspapers, type of neighborhood, kind of school, insufficient religious faith, insufficient family income, discrimination, and crowded apartment or house. Finally, respondents were asked: “Looking to the future, how much responsibility should the following people have in solving or improving the main problem-a lot, some, a little, or not at all?’ Response items included the youth, mother, father, teachers or school staff, probation officers or court officials, county family caseworkers (family crisis interven-

4 tion unit counselors in New Jersey), men tal health counselors, ministers or clergy, and medical doc- tors or nurses. All questions were based on a Lik- ert-type scale in which I=a lot, 2=some, 3=a little, and ‘$=not at all. As appropriate to analyses, vari- ables were retained as interval level or were coded dichotomously with I=a lot of responsibility, and 2=not a lot (remaining categories: some/a littlehot at all).

Analyses Analysis was conducted in two phases. Sources

of agreement and disagreement between parents and professionals in their causal attributions were assessed conducting the Wilcoxon signed rank test for paired samples, with p<.05 indicating significant discord. Reports were made of the number/ proportion of times that parent scores were lower than. higher than. or equal to professional scores, permitting direct comparison of parents’ and professionals’ ratings of the causes of individual youths’ problems.

The second phase of analysis investigated the opinions of parents and professionals about who should be responsible for solving the problems of the adolescents, controlling for the cause of the problem. Analysis compared parental to professional relative risk estimates. The relative risk estimates (the ratios of two incidence rates) repre- sented a ratio of attribution of responsibility to a given individual for a primary role in solving the problcrn under two distinct conditions: u) when the controlled-for causal factor was assigned “a lot” of (1.e.. primary) responsibility for causing the problem; and hi when the factor was assigned less than primary causal responsibility. This parameter indi- cated the strength of association between the cause of. the problem (exposure to risk factor) and the

likelihood of a particular individual being selected for a primary role in solving the problem (occur- rence of event or outcome).

For example, the incidence rate was calculated as the probability of assigning a primary solution role to the clergy when primary causation was attributed to the child, compared to when it was not so attributed. The estimate is the ratio between the incidence rates for the event when the factor is present and when the factor is absent. Practically speaking, a relative risk of 2.54 means that respondents are two and one-half times more likely to assign solution responsibility to a particular person when they report a given cause than when they do not report that cause. A 95% confidence interval around the relative risk estimate that includes the value of 1 indicates that the cause (risk factor) is not associated with the solution (event). Such lack of association means that this solution is no more likely to be assigned a heightened role in the presence of this cause than in the absence of this cause. For instance, if none of the solutions to a given cause has a significant relative risk estimate, this cause does not logically suggest an enhanced role for any of the possible individuals in solving the problem resulting from this particular cause; all individuals are viewed as equally responsible.

Perspectives of parents and professionals were compared by examining which individuals were assigned significant relative risk estimates to solve the problem, controlling for a given cause.

RESULTS Causal Responsibility

Differences between mothers and professionals in attribution of responsibility for etiology are shown in TABLE 1 . The first hypothesis-attribution of causal responsibility to mothers is significantly less likely among mothers than among professionals-was supported. Less than 9% (8 of 9 I ) of mothers attributed greater causal responsibility to themselves than did professionals, and more than half (50 of 91) attributed less causal responsibility to themselves than did professionals. In 36% of cases (33 of 91)? mothers and professionals were in complete agreement. Moreover. as is shown in TABLE I , professionals attributed greater etiological responsibility to most of the possible causes listed than did mothers-to fathers, siblings, heredity, bad health, the media, insufficient income. poor housing. discrimination. and insufficient religious faith.

430 Attributions of Responsibility

Table 1 ATTRIBUTION OF CAUSES: PARENTS VERSUS PROFESSIONALS ( k 1 0 2 . )

OBSERVED PARENT < PROFL PARENT > PROFL PARENT = PROFL CAUSE CASESN MRANK N MRANK N N Z P Child 97 31.36 28 27.77 30 39 -0.18 NS Mother 91 32.06 50 13.50 8 33 -5.89 0.001 Father 73 26.45 39 24.54 12 22 -3.50 0 001 Siblings 88 27.27 45 21.57 7 36 -5.03 0 001 Child‘s friends 95 30.13 24 27.28 32 39 -0 63 NS Heredity 89 35.70 57 19 56 9 23 -6.04 0.001 Bad health 94 45.62 84 21.00 4 6 -8.22 0 001 Neighborhood 99 36.89 32 40.50 45 22 -1.65 NS School 96 35.53 31 35.47 39 26 -0.84 NS Media 94 35.88 49 36.27 22 23 -2.80 0.01 Insufficient income 96 36.98 50 38.58 24 22 -2.52 0.01 Crowded dwelling 97 38.35 59 31.32 14 24 -5.11 0.001 Discrimination 95 40.74 74 29.00 5 16 -7.12 0 001 Insufficient religious faith 87 41.47 65 29.65 13 9 -5 84 0.001

Note. Report based on Wlcoxon signed rank test for paired samples. ‘Unit of observation is youth (N=102) with mental health problems, maternal N=102. professional N=38

The second hypothesis-mothers and professionals are likely to agree on the level of causal responsibility borne by the child-was also supported. No significant differences were found between mothers and professionals on the degree of etiological responsibility that the child bore. The proportion of cases in which the parental rating was higher than the professional rating approxi- mated the proportion in which the professionals’ rating was higher than the parental rating. Discrep- ancies in mean rank were relatively minor. Simi- larly, no significant differences were found between mothers and professionals on level of responsibility assigned to peers, school, and neighborhood.

Solution Responsibility Perspectives of mothers and professionals were

compared by examining which individuals were assigned significant relative risk estimates to solve the problem, controlling for a given cause (see TABLE 2). Results showed whether mothers and professionals had a common view of the child’s role, of the mother’s and father’s roles, and of the roles of the mental health professional and other formal youth service system helpers in solving problems.

The third hypothesis-when mothers and professionals attribute a lot of causal responsibility to the child for the problems, they are likely to agree that the child has a primary role in solving it-was also supported. When they assigned primary causal responsibility to the child, risk of assigning enhanced solution responsibility to the child was I ,39 for professionals and 1.53 for parents. No as-

signment of enhanced roles for others were found; thus mothers and professionals agreed that primary responsibility fell on the child.

Mothers and professionals also agreed that the child had enhanced responsibility for solving the problem when they attributed causation to siblings or peers. For mothers, the relative risk for siblings and peers was 1.29 and 1.38, respectively; for professionals, it was 1.23 and 1.24, respectively.

The fourth hypothesis-when mothers and professionals attribute a lot of causal responsibility to the mother for the child’s problem, they are likely to disagree about the mother’s role in solving it- was not supported: professionals were no more likely to assign the mother an enhanced role in the solution than were the mothers themselves. How- ever, this was the only condition under which they agreed on mothers’ solution responsibilities. Moth- ers assigned enhanced responsibility to themselves for solving problems caused by media (relative risk= I .42), crowded housing (relative riskzl.36). and insufficient religious faith (relative risk= I .43). By contrast. professionals attributed enhanced responsibility to mothers only for solving problems caused by siblings (relative risk= I .32).

Mothers and professionals also had different perspectives on the fathers’ solution responsibilities. Mothers attributed enhanced responsibilities to fathers for solving problems caused by peers (relative risk= 1.65), insufficient income (relative risk=2.06) and crowded housing (relative risk= 2.02). Professionals attributed enhanced responsibility to fathers when the primary causal condition was the father (relative risk= I .95), neighborhood conditions (relative risk= I .97). or insufficient reli-

Pottick 6 Dcluis 43 2

Table 2 PARENT AND PROFESSIONAL AlTRlBUTlONS OF SOLUTION RESPONSIBILITY:

SIGNIFICANT RELATIVE RISK ESTIMATES

PARENT PERSPECTIVE SOLUTION REL RISK 95% CI

RATIO LOWER-UPPER CAUSE RESPONSIBILITY Child Mother Father

Siblings

Child's friends

Heredity Bad health Neighborhood

School Media Insufficient income

Crowded dwelling

Discrimination lnsuff religious faith

Child

Clergy MHP Child MHP School Child Father MHP School staff

PO Mother Clergy PO Father CFS School staff Mother Clergy Father School staff Clergy Mother

153 1.18

3 97 1 02 2 04 158 129 116 3 44 2 51 3 88 2 75 138 116 165 100 3 06 180 3 96 2 80

5 15 139 142 1 1 5 6 50 2 04 3 58 107 2 06 1 30 199 102 195 101 1 36 1 07 5 15 172 2 02 123 2 76 141 3 56 114 143 117

199

1543 5 1 1 144 4 73 5 47 163 2 72 5 17 5 59

19 10 1 76 20 67 1 1 93 3 25 3 86 3 76 173 15 45 3 30 5 40

1 1 10 1 76

PROFESSIONAL PERSPECTIVE SOLUTION REL RISK 95% CI

RESPONSIBILITY RATIO LOWER-UPPER Child 139 118 MHP 2 42 133 Father 1 95 114

Child 123 1 1 1 CFS 2 56 120 Mother 132 117 Child 1 24

Father 1 97 MHP 2 07

MHP 193

Father 2 01 102

1 64 4 41 3 32

137 5 43 149 138

3 32 3 63

3 41

3 97

Note Unit of observation IS youth (N=l02) with mental health problems, maternal N=l02. professional N=38 CI=confidence interval MHP=mental health professionals. PO=probation officers, CFS=county family caseworkers

gious faith (relative risk=2.01). I t is noteworthy that when mothers attributed a lot of causal responsibility to fathers, they assigned no additional solution responsibility to them.

Mothers and professionals conceptualized the role responsibilities of mental health professionals differently. Mothers expected mental health professionals to take additional responsibility for problems caused by fathers (relative risk=2.84), heredity (relative risk=3.06), and siblings (relative risk=3.44). On the other hand, professionals expected to have enhanced responsibility for problems caused by mothers (relative risk=2.42), neighborhood conditions (relative risk=2.07), and the media (relative risk=1.93). No overlap was found in these expectations.

Mothers and professionals also had different concepts of the responsibilities of other formal helpers in the youth service system. While professionals assigned no enhanced solution responsibility to clergy, mothers assigned it to them when the father (relative risk=3.97). insufficient income (relative risk=6.50), crowded housing (relative risk=S. 15). and insufficient religious faith (relative risk=3.56) were causes.

Professionals assigned no enhanced solution responsibilities to teachers, school staff, probation officers, or court officials. Mothers, on the other hand, assigned enhanced solution responsibility to teachers and school staff when bad health (3.96), insufficient income ( I .95), and discrimination (2.76) were causes. They assigned solution responsibility to probation officers and court officials when kind of school (relative risk=S. 15) and insut- ficient income (relative risk= 3.58) were causes.

Professionals assigned enhanced solution responsibility to county family caseworkers when siblings were implicared in the problem (relative risk=2.56). Mothers assigned it to them when insufficient income (relative risk= I .99) was the cause.

DISCUSSION Three of the four hypotheses were supported by

the data. First. consistent with expectations based on attribution theory, mothers assigned themselves significantly less causal responsibility than did professionals. Second, also consistent with attribution theory. mothers and professionals tended to agree on the child's level of responsibilit) for

432 Attributions of Responsibility causing the problem. From the professionals’ perspective, the mother was both actor and observer; from the mother’s perspective, she was an observer only. The results extended attribution theory on actor-observer differences to a three-party situation in which any individual was an actor and, simultaneously, an observer of a third party. Both mothers and professionals acted as observers of the child. Thus, family treatment with children may be considered a case of triangulated attributions that create theoretically expected etiological perspectives.

Third, confirming expectations based on Brick- man and colleagues’ conceptualization (1982), both mothers and professionals believed that children should take considerable responsibility for solving problems that they themselves had largely caused; i.e., they appeared to endorse the moral model of helping in respect to the child. When the child was viewed as causing the problem, no other parties were assigned heightened solution responsibility; i.e., the enlightenment, medical, and compensatory models were not viewed as appropriate to helping when the child was implicated in the cause.

Inconsistent with expectations based on Brick- man and colleagues’ framework (I 982), professionals were no more likely to assign mothers an enhanced role in solving problems they believed the mother to have caused than mothers themselves were; i.e., neither mothers nor professionals saw an enhanced role for mothers. It was hypothe- sized that professionals would endorse a moral model of helping, .lust as they did in the case of the causally responsible child; and that mothers, de- faulting on their own solution responsibilities, would endorse an enlightenment model (in which others were responsible for solving the problem that they themselves had caused). However, findings demonstrated that professionals, rather than mothers, endorsed the enlightenment model; i.e., shouldered greater responsibility for solving problems they believed had been caused by mothers.

The findings showed some evidence that when a caregiver other than the mother accompanied the adolescent to the social agency, professionals were likely to assign greater solution responsibility to the mother for a problem she had largely caused. For further investigation, a risk ratio analysis was conducted on a sample that included both the 102 mothers and the I7 other caregivers (fathers, step- fathers, brothers-in-law, aunts, sisters, and grand-

mothers). With this small shift in sample, professionals were found to attribute enhanced responsibility both to the mother (relative risk ratio=l.23, confidence interval= 1 .OO 1-1.5 19) and to themselves (relative risk ratio=2.38, confidence interval=l.3374.253). Under this particular condition, then, assignment of an enhanced solution role to mothers when they were absent from the treatment encounter supported the fourth hypothesis (i.e., the moral model). Perhaps the presence of the mother was regarded by the professionals in the sample as sufficient evidence of a commitment to solving the problem. In practical terms, it seems that urban mothers of children with mental health problems should make every considered effort to accom- pany the child rather than send a surrogate to professional interviews if they want professionals to view them as assuming appropriate role responsibilities.

Professionals were found to attribute greater etiological responsibility to most of the causes listed in the survey than were mothers, perhaps because they are trained to identify causes for clients’ problems. Increasing our knowledge about the effects of training on ways of perceiving problems may help clarify those perceptions and thus improve professionals’ capacity for successful engagement and intervention with clients.

The finding that mothers expect professionals to solve problems caused in large part by heredity suggests that mothers may medicalize mental health professionals. Professionals report no such role for themselves. I t might therefore be more productive for service delivery and use if professionals and family members were to clarify and negotiate their roles in treatment.

That mental health professionals assign themselves enhanced responsibility for problems caused by neighborhood conditions and the media is encouraging if it implies an active commitment to solving some environmental problems. Cer- tainly, i t is possible for clinicians to work with other professionals and parents to solve children’s problems. However, such community activity is rare, since the demands of agency-based practice tend to keep practitioners office-bound and limited to working with the nuclear family. Results of the present study revealed that urban mothers per- ceived a larger role for the system of helpers than did professionals: they attributed enhanced solution roles to the clergy, teachers, probation officers and other court officials, county-based family

Pottick 6 D m i s 433 caseworkers, and fathers for many environmentally caused problems.

Results of this study suggest the existence of other untapped opportunities for strategic expan- sion of the professional mental health role to in- clude linkage and coordination. In fact, enhanced solution roles were assigned to two or more parties by mothers in six of the 14 causes, compared to such assignment by professionals for only two of the 14 causes. This finding that mothers assigned a wider range of solution roles for themselves and others than did professionals indicates that professionals may unwittingly underutilize potential helping networks for solving their child clients’ problems.

1 iiiplicntiotis for Cliii icd in feruen tioii Four recommendations for strategic clinical in-

terventions stem from the results of the present study. First, if professionals build on their common role with parents as observers in relationship to the child, they are more likely to engage parents in a successful working alliance. Since professionals and mothers showed agreement on children’s causal and solution responsibilities, the initial intervention focus might be on activities that directly motivate youths to solve problems that both believe the child has caused, as well as problems they both believe to be caused by children’s siblings and peers. Several intervention strategies, includ- ing cognitive behavioral approaches to working with youths as individuals and in groups, have demonstrated success in enhancing motivation (Gcrhcr R Bushum, 1999; Rose. 1998).

Professionals appeared to believe that mothers and children should both have primary solution responsibility for problems caused by siblings; this amounts to an opportunity for professionals to of- I tr effective services to parents as well as their children. Because family intervention techniques have been shown to be effective with high-risk, t roil b led adolescents /HenggeIer, Schoenwald, Borditin R Rowlund, 1998), whole-family treatment is to be recommended. The relative success of family treatment may be due, in part, to professionals’ beliefs in the demonstrated enhanced re- ymnsibility of parents who commit to whole- family involvement and participation. This inter- pretation is congruent with the present finding that professionals are more inclined to absolve parents of primary responsibility for solutions when they conduct the child to interviews in person, rather

than sending a surrogate. Professionals who work with whole families do so from the common as- sumption that the families are already motivated but need specific skills for enhancing their children’s motivation. This is good common ground for an effective alliance between parents and professionals and for effective treatment of the youth.

Second, as clinical work continues, professionals and parents can capitalize on their different viewpoints about solution responsibility by ana- lyzing the discrepancies between their two perspectives and engaging mothers in terms of the basis of the disagreement. This should increase the probability of negotiating mutual role responsibilities for solving problems. A focus on activities that illuminate the differences between professionals and parents presents an opportunity of pointing out their respective attributional perspectives as actors and observers vis-a-vis the family system. When parents and professionals understand that their views are different in some respects, and similar in others, they are more likely to clarify the differences so as to discover solutions that were previ- ously camouflaged. This can be simply expressed by ruling that when either party sees a significant solution role for a given individual, both should work equally and collaboratively toward a common perspective on what that role-player has to of- fer for the solution. This is an opportunity for professionals, in using their common ground to engage mothers as mutual observers of the family system, to facilitate a working alliance in service to the child.

Third, the fact that mothers in this study revealed a wider range of solution attributions suggests that a collaboration of professionals and parents could activate a network of helpers outside the family and the professional mental health service system. By recognizing that parents have a larger network of helpers in mind to help solve problems stemming from environmental conditions (e.g., crowded homes, poverty, poor schooling). mental health professionals are more likely to facilitate effective collaborations with other youth service systems. They should focus on activities that identify the individuals from whom parents want to get help and those with whom they would like to work in doing so. For instance, mothers in the present study identified teachers and school staff as especially responsible for solving problems caused by discrimination (relative risk ratio=2.76). Collabo- ration between the mental health and educational

434 Attributions of Responsibility systems could stimulate the development of effective social programs in schools to reduce bias, prejudice, and discrimination among students, and between students and school staff. In controlled clinical studies, models of school-based services have been shown to have remarkable rates of ef- fectiveness (Conduct Problems Prevention Re- search Group, US, 1999). Calls for interprofes- sional collaboration, especially in the area of school mental health services, are emerging in the professional literature (Kubiszyn, 1999).

Fourth, an analysis of causes and solutions can be incorporated into the clinical interview in ac- cordance with individual clinical style. The usual standard interview process includes little, if any, effort to discern parents’ attributions. Profession- als can change this by actively sharing their own perspectives on causal and solution responsibility with parents and making an explicit effort to solicit and consider the parents’ perspectives. For instance, the findings reported here might be intro- duced to begin a mutual conversation with parents about responsibilities for causes and solutions. Al- ternatively, professionals might initiate a conversation about responsibility in an open-ended man- ner by sharing their own perspectives, and simultaneously soliciting parents’ opinions. As with all interviewing skills, clinical judgment will determine timing and pacing of interactions throughout the treatment process.

Linzitations ofthe Study While these data have helped to build a profile

of attributions of responsibility from the perspectives of parents and professionals, they have a number of important limitations. First, the study does not measure factors within individuals (e.g., ability, motivation, or personality) that may be responsible for the problem’s cause or solution. Consequently, the results cannot pinpoint detailed mechanisms of attributional processes among parents and professionals. Evidence in the literature demonstrates that parents’ psychiatric symptoms influence their perspectives on children’s problems (Cornpus, Phares, Banez, & Howell. 1991; Phures, Cornpus. & Howell, 1989; Renouf &i Ko- vacs. lYY4). Future research should attempt to cap- ture these nuances.

Second, the relatively small sample size of 102 mothers limited the ability to match specific children with professionals and parents, while controlling for multiple causal strategies. Early analyses

of these data revealed few differences between parents’ and professionals’ descriptions of the youths’ problems based on matched scores on the Achenbach Child Behavior Checklist (Achenbach & Edelbrock, 1983); thus it seems probable that they are reporting on the same population of youths. However, small sample sizes do not permit control on the nature of the child’s problem.

Third, different occupational groups could have distinct attributional schemas, but comparisons were not possible due to both sample size limitations and the heterogeneity of educational backgrounds within occupational specializations. More importantly, parents were not randomly assigned to different professionals. Future experimentally controlled research is necessary to test occupational differences in attribution, since a discovery of bias could have important implications for professional education and training.

Fourth, these analyses are based on data from 1988. While theoretically driven studies may be considered timeless, there might be differences in the distribution of causes and solutions in more contemporary data.

Finally, only the perspectives of mothers and professionals were tested in this research. Since many mental health interventions involve family systems, clinical practice would benefit from studies that systematically compared the attributional perspectives of fathers and children, as well as those of mothers, and professionals. To increase reliability, such studies should incorporate tested survey methodologies that ensure privacy during interviewing (Compas, Adelman, Freundl, Nelson, & Taylor, 1982).

Despite these limitations, the data are strong enough to indicate both similar and dissimilar perspectives on the part of parents and professionals, that can be theoretically understood and analyzed. Such understanding could be used to improve practice interventions for helping children and their families.

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For rc-prints: Knthleen I. Pottick, Institute for Health, I lealth Care Policy, and Aging Rrsearch, Rutgcrs University, 30 CnHegc Avenuc, Newt Hrunswick, NJ 08903

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Attributions of Responsibility for Children's Mental Health Problems: Parents and Professionals at Odds