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  INFLUENCE OF FAMILY ENVIRONMENT AND SOCIAL SUPPORT IN THE UTILIZATION OF MENTAL HEALTH CARE SERVICES KRIPARAJ K. BOBBY Ph.DScholar, Pondicherry Univeristy, Kalapet, Puducherry Email  INTRODUCTION Mental retardation is a condition of arrested or incomplete development of brain which is especially characterized by the impairment of skills manifested during the development period.. The American Association on Mental Retardation (AAMR), defines Mental Retardation (MR) as “A disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills ” . Beliefs about mental health and illness are culturally derived or may emerge from socialization experiences linked to social roles,   religious beliefs, cultural values, and economic conditions.Since mental retardation is a developmental disability with lifelong effectand a child with special needs requires special care and heightened attention, it will be very challenging for parents of retarded especially to find ways to prepare these children to handle their daily living and future tasks.As Society‟s view s of disability may reflect in the treatment of children with retardation, perceived social support is very important for families having children with mental retardation . Addressing the complex needs of families with retarded child and to overcome the problems of emotional and/or behavioral of their children requires a comprehensive, coordinated approach. The strength of the family in thepromotion of the mental health and utilization of available services fortheir retardedchildren is largely depends upon the family environment, perceived social support, socio-economic status and the knowledge of the family members. On these assumption and to fill the gaps of previous studies the researcher selected the Ph.Dtopic in the area of mental health care service utilization and the title given as “Pr  edictors of the Utilization of Mental health care services for children with special needs”. Mental health care services are increasingly being seen as a major proximate determinant of decreased morbidity in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization.Recently, there  has been a renewed interest in the health care experiences and unmet needs of children and adults with mental retardation (Horwitz,Kerker, Owens, &Zigler, 2001). Previous studies have compared parent reports of service utilization to administrative records within a managed care setting (Bean et al. 2000), and within a hospital (Fendrich M., et al. 1999).However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. Accurate assessment of children‟s mental health service use is needed to understand how families access care for both service planning and research Researcher hope that an in-depth study on this area would be helpful in finding out the current  problems and inadequacies of service utilizations and thus initiate steps to improve utilization of mental health care services for child with mental retardation. Keeping this in mind researcher selected above topic for a detailed study. What reviews related to the topic says and what prior researchers left out are discussed below. PREVALENCE OF MENTAL RETARDATION IN INDIA The prevalence rate of mental retardation in India is estimated to 4.2 per 1000 population (Madhav, 2010).The prevalence varies considerably because of the varying criteria and methods used in the surveys as well as differences in the age range of samples. Mental retardation occurs in 2.5-3% of the general population. Out of which 85% are mild, 10% are moderate, 3-4% are severely retarded and rests are profound mentally retarded (Hussain, et al, 2010).Kerala State Mental Health Authority (KSMHA) figures show that 5.3 per 1000 population have mental retardation (Radhakrishnan, 2011).People with mental retardation have become more visible in the community. It is more common in developing countries because of the higher incidence of injuries and anoxia around birth and early childhood infections. AIM OF STUDY To understand the factorsinfluencingin the utilization of mental health care services for children with special needs with special reference to Kozhikode city corporation, Kerala    SPECIFIC OBJECTIVES To study the socio-demographic profile of respondents To know the socio-economic status of respondents To assess the knowledge and utilization of respondents on child mental health care services To understand the quality of family environment of children with special needs To examine the perceived social support among parents of children with special needs To suggest social work measures to improve family environment, social support for an enhanced level of utilization of available services for children with special needs FAMILY ENVIRONMENT AND SOCIAL SUPPORT IN FAMILIES OF RETARDED CHILDREN For some families, although parenting a child with a disability may test their relationships, it can serve to draw couples closer together as they work to adapt their family life to the needs of the child (Heiman, 2002). This particular study is attempted to study how the family environment influence on the utilization of services as the family environment is of the product from the stress, strain burden experienced by the parents, relationships in the family and their coping skills. Families are complex systems that may become even more complex with the addition of a child with mental retardation; an event that introduces new potent and new challenges. Parenting a child with a developmental disability is more like parenting a normally developing child than it is different. There are, however, additional challenges that often loom so large that considering them tends to obscure the commonalities in what parents experience. It is essential to recognize as we focus on parenting children with mental retardation that most parenting considerations are similar to those with normally developing children. Although virtually no parent would wish for retardation in a child, when faced with the reality most parents respond with acceptance and love, as with the birth of any child. Not surprisingly,  most parents also experience heightened stress. As the child fails to meet first one developmental milestone and then another and another, parents are faced with unique challenges. We will consider the primary ways that children with mental retardation deviate from expected development and the adaptations in parenting that ensue. Fortunately, most parents find ways to cope, sometimes aided by supports and services from outside the family. Parenting is, of course, greatly influenced by forces beyond the child and family, suchas day care and school programs, service agencies, workplace practices, religious institutions and practices, governmental laws and practices, and subcultural and cultural expectations. Although a thorough consideration of these influences is beyond our scope here, we will mention several major factors that affect parenting a child with a developmental disability in the United States at the closeof the 20th century.   Having a handicapped child born into a family and grow into adulthood is one of the most stressful experiences a family can endure. Parental and peer rejection, negative social relationships, limited supports, and exposure to degrading situations also may make functioning in the community difficult for those with MR. (Reiss S, Benson BA 1983).Parental reactions to the realization that their child is exceptional usually include shock, depression, guilt, anger, sadness, and anxiety. Individuals handle each of these feelings differently and may stay in certain stages longer than others. Some parents perceive the handicapped infant as an extension of them and may feel shame, social rejection, ridicule or embarrassment. Parental reactions may be affected by economic status, personality traits and marital stability. In short, an initial parental response may be a form of emotional disintegration. This may evolve into a period of adjustment and later into reorganizati on of the family‟s  daily life. Some parents cannot cope beyond the emotional disintegration. They must then decide whether to give the child up for adoption or to  place him in an institution. This decision is not easy and is stressful to the family. However, the concern here is with the family that chooses to raise their special youngster at home. Measuring levels of perceived social support among families with retarded children could be of use in designing support activities for these families. With these considerations in mind, this study aims to examine social support perceived by the parents of a retarded child. The study aims  to assess variables associated with mental healthcare service utilization in general and in both  primary and specialized care by the parents for their retarded children. The study also research examining the demographic and socioeconomic characteristics of families of children with mental retardation that impact the economic situations of families.Financial impacts on families with a child with disabilities can result from high out-of-pocket expenditures and reduced  parental employment and earnings. Many families of children with disabilities experience financial stress. To understand the financial status of an instrument named socio-economic status scale has been administrated. The present study examined socio demographic inequalities in the use of mental health services  by young adults, and examined whether such inequalities were attributable to differences in objective need, subjective need, predisposing or enabling factors. The intent of this study is to shed light on caregivers and the use of mental health services for their children, and therefore, have implications for improving service delivery and mental health outcomes for the large  population of underserved children in the child welfare system. An interview schedule and a check list administered including questions on socio-demographic factors and mental health service knowledge and use. FAMILY SUPPORT PROGRAMS AND MENTAL HEALTH CARE UTILIZATION Family support programs are based on the goals of strengthen-ing families' ability to care for their relatives with disabilities as well as improving the well-being of caregivers and their relatives with disabilities (Dunst, Trivette, Starnes, Hamby, & Gordon, 1993). Most family support programs for people with disabilities in the United States were developed with the  purpose of helping families maintain persons with disabilities within the family home (Heller, 1998). Early family support programs provided discrete services such as respite care, counseling, and parent training ser-vices. Agencies or professionals directed these services. In some states, cash subsidies were later added. The movement towards community empowerment and recognition of the need for persons with disabilities to remain in their communities led to the
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