1. Study on well-being of children and their caregivers of the incarcerated 在囚人士子女成長發展研究 Dr. Eric Chui 崔永康博士 Department of Social Work and Social Administration The University of Hong Kong 香港大學社會工作及社會行政學系

2. Introduction – Child Development Imprisonment of a parent brings about negative consequences (Partners of Prisoners & Families Support Group, 2007) - Emotional level: learning to deal with new thoughts and feelings such as shame, isolation, confusion and grief - Behavioral change: aggression, difficulty concentrating, anxious, withdrawn and clingy towards the remaining parent or caregiver Protective factors: social support from non-family members, positive parent-child relationship, religiosity, a positive sense of self (Nesmith and Ruhland, 2008)

3. Introduction - Caregiver well-being Stigma and disclosure: Children and caregivers might suffer from stigma attached to the imprisonment of a parent; the family may therefore protect the child by requiring secrecy in certain settings (Hagen and Myers, 2003) Economic deprivation: the removal of a parent might lead to the loss of an important “breadwinner” and the remaining parent might have less time and less money to invest in the children (Laing and McCarthy, 2002) High level of parenting stress have been associated with parental depression, less effective parenting behaviour, and poor child outcomes (Loper, Carlson, Levitt, & Scheffel, 2009)

4. Background and Aim 背景 A joint investigation with the “Blue Bus – Trip for Growth” project, the Society of Rehabilitation and Crime Prevention, Hong Kong( 香港善導會藍 巴士 -- 成長之旅合作進行研究 ) Aims of the study: to examine competences and behaviour patterns of offender’s child( 兒童行為 ) and the relation with caregiver’s psychological well-being ( 照顧者的身心健康 )

5. Method 研究方法 80 caregivers ( 照顧者 ) were asked to complete a questionnaire : (1) General Health Questionnaire (GHQ) ( 健康狀況 量表 ) (2) Social Support scale ( 社會支援量表 ) (3) Stress level scale ( 生活壓力量表 ) (4) Beck Depression Inventory ( 貝克憂鬱量表 ) (5) Discrimination scale ( 面對的社會歧視量表 ) (6) Child Behaviour Checklist (CBCL)( 兒童行為量表 )

6. Caregiver’s well-being 貝克憂鬱量表 * Source: Mittelman, M. S., Brodaty, H., Wallen, A. S., & Burns, A. (2008). A three- country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: effects on caregiver depression. The American Journal of Geriatric Psychiatry, 16, 893-904.

7. Caregiver’s well-being & mediation study with child’s behavior 照顧者的身心健康與兒童行為問題

8. Correlations between caregiver’s well-being & CBCL * 照顧者 的身心健康與兒童行為量表 Social support ( 社會支援 ) Perceived discrimi nation ( 面對的社會 歧視 ) Stress ( 生活壓力 ) Depression ( 抑鬱 ) General health ( 健康狀況 ) Problem Scale ( 問題量表 ) ---.43-.31 Internalizing ( 內化問題 ) --.35.49-.31 Withdrawn ( 退縮行為 ) ---.35-.28 Somatic complaints ( 抱怨身體 症狀 ) ---.41-.30 Anxious-depressed ( 憂鬱 / 焦慮 ) ---.41-.21 Externalizing ( 外化問題 ) -.29-.28.41-.50 Delinquent ( 犯罪行為 ) -.28-.31- Social ( 社交問題 ) ---.32-.29 Thought ( 問題思想 ) -.34.35-.49-.22 Attention ( 注意力問題 ) ---.37-.28 *p<.05

9. Mediating Effect of Caregiver’s Depression between Caregiver’s Stress and Child’s problems 仲介效應分析 : 看護者的生活壓力 、抑鬱和兒童行為問題 The stress perceived by the caregiver was associated positively with the severity of the problem presented by the child, including emotional disturbance and disruptive behaviors, as measured by CBCL The psychological wellbeing of the caregiver, measured in terms of levels of depression, would mediate the above relationship 照顧者的生活壓力對自兒童的外化及內化問題均有直接效果 (direct effect) ，而抑鬱作為一個中介變項 (mediation variable) 則解讀了兩者間的關聯。 研究成果表明，在囚 / 更生人士孩子的照顧者在生活中面臨很 大的壓力，並有明顯抑鬱徵兆。這些精神及情緒問題更直 接影響他們照顧的孩子，誘發孩子的行為和情緒問題。

10. Child Behavior Checklist 兒童行為量表

11. Child Behavior Checklist 兒童行為量表 *The Child Behavior Checklist (CBCL) assesses social competencies and behavioral problems of children as reported by parents. Social competencies are measured by the 20-item Competence Scales, which consist of three sub-scales (i.e. activities, social, and school). The Problem Scales consist of 120 items on behavior or emotional problems during the past 6 months, and assess internalizing problems (i.e., withdrawn, anxious/ depressive behaviors, & somatic complaints) and externalizing problems (i.e., delinquent & aggressive behaviors), as well as social, thought, & attention problems (Leung et al., 2006).

12. *Cases defined by borderline cutoff, which include scores falling within the borderline clinical and abnormal ranges (Achenbach, 1991) ** Source: Chang, S., Ng, C., & Wong, S. (2002). Behavioral problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong. Acta Paediatrica, 91, 475-479. Child Behavior Checklist 兒童行為量表

13. Compared with general population: Fewer Blue Bus service users are categorized as problematic cases in Competence Scale and more cases in Problem Scale 在服務使用者的組別中，有較多的兒童出現行為和情 緒問題，包括外化及內化問題，卻有較少的能力問 題個案。 Child Behavior Checklist 兒童行為量表

14. Child Behavior Checklist & disclosure of parent’s incarceration 孩子的行為問題與是否知悉父母 被捕入獄

15. Condition of Disclosure 孩子的行為問題與是否知悉父被捕入獄 Age first learnt about parent’s incarceration 3-14 years old Mean age = 7.26, SD = 2.9 If the child know the parent’s incarceration ( 知悉父被捕入獄 ) From where did the child learn the incarceration FrequencyPercent No2936.3 Yes5163.8 FrequencyPercent Incarcerated parent 1122.0 Caregiver 3162.0 Other 916.0 * Other includes learning from other relatives, overhearing the issue from family’s conversations, social worker, and the child discovers the issue by himself.

16. Difference of Disclose or not 孩子的行為問題與是否知悉父母被捕入獄 Mean （平均分） FSig Not Disclose (N=13) Disclose (N=46) Competencies Scale ( 能力量表 ) 40.446.3-1.73.09 Problem Scale ( 問題量表 ) Anxious/ Depressed ( 憂鬱 / 焦慮 ) 61.056.21.95.06 Social ( 社交問題 ) 59.754.72.23.00 Attention ( 注意力問題 ) 62.054.93.08.04 Aggressive ( 攻擊行為 ) 58.454.42.04.05

17. Difference of Disclose or not 孩子的行為問題與是否知悉父母被捕入獄 Disclose/ not has a relation with child’s well- being Children who do not know the incarceration score poorer on the competence scale and 3 of the problem sub-scales, i.e. being less competent and having more behavioral problems 在不知道的組別中，有較多的兒童出現注意力問題、攻 擊性行為及社交問題。