Programs for Parents with Mental Illness: Part 2

by SAMHSA

(Page 20 of 20)

Differences across programs in comprehensiveness and family-centeredness appeared to be related to types of services provided, and the treatment mode in which they were provided. More comprehensive programs generally involved a case management, home-based approach. Coordination of services and collaboration with multiple providers were essential to supporting families effectively. Programs among the high and lower specificity groups that were unable to provide or access these components expressed frustration, and burn-out.

Finally, although programs shared the basic goal of supporting families in which a parent has a mental illness, targeted outcomes differed. Several programs had very specific and concrete goals, such as improving parent-child communication, or increasing a parent's understanding of child development. Other programs focused more singularly on functional adaptation of the parent, and fulfillment of necessary adult roles, of which parenting was one. More comprehensive programs often targeted loftier goals, such as enhancing the quality of life for all family members, by supporting the development of multiple life skills and illness management, in addition to parenting. Several programs that worked closely with the child welfare system focused on family preservation and/or reunification, and provided a range of services related to the accomplishment of that goal.

Limited Evaluation Resources

Unfortunately, programs reported that they had very limited resources for evaluation. Outcome data were typically collected on variables related to agency mandate and to meet the requirements of specific funders. Most programs collected parent/child satisfaction data, and reported high levels of satisfaction. Client outcomes were generally captured in service plans, treatment goals, and progress, and most providers reported gains by most program participants. However, standardized, objective evaluation data on parents and their children that could be compared across programs or generalized to other populations were not collected by programs. Therefore, an empirically-supported knowledge base of effective practices has not been developed.

Two Examples. Two programs provide noteworthy exception. Beardslee and colleagues have developed an intervention for families and children ages 8 to 15 years, in which one of the parents has had a recent hospitalization for an affective diagnosis (Beardslee et al., 1996b, 1997a, 1997c). Based on the literature of risk and resilience, the intervention uses a psychoeducational approach to educate parents about the potential impact of their illness on children, and to enhance communication between parents and children about mental illness. The importance of distancing the child's self-concept from the parent's illness is emphasized in an effort to support resiliency among children. Longitudinal follow-up of approximately 40 families indicated the intervention has been effective using both a clinician-based family therapy, and non-clinician didactic model (Beardslee et al., 1997a, 1997b, 1997c). Parents and children reported improved knowledge and communication about mental illness. Parents reported increased marital support and better understanding of each other's feelings. In addition, children reported improved understanding of parental disorder, and better overall functioning after the intervention (Beardslee et al., 1997c).

Using a very different approach, Musick et al. (1987) have developed a therapeutic nursery model for children aged 0 - 5 years who have a mother with a mental illness. The focus of their intervention is on providing a stimulating environment that fosters child growth and development, along side parent coaching. Analyses of developmental scores indicate that children are improving and achieving development. Differences between children appear to be related to differences in caretaking behavior by their parents. Children who did better had mothers who showed some ability to see the child as a separate individual and to support his or her growth and development even when doing so was inconsistent with the mother's own needs. Success for children was also associated with more positive mood, reciprocity, and emotional responsiveness. In addition, resilient children had higher functioning and more supportive family networks, including an available and involved father.

SUMMARY: Despite the existence of innovative and promising programs, there are few programs relative to the need, given the prevalence rates suggested by epidemiological data. Program providers have great difficulty finding and sustaining funding, and continue to struggle with systems using categorical funding structures ill-suited to family-centered services. As a result, programs reflect the approaches of their primary funding sources and may lack the flexibility and/or comprehensiveness needed by this population. Finally, research literature has not been systematically integrated into program conceptualization, development, and design; and evaluation data have not been collected to allow for the development of empirically-supported services. As a result, outcomes for individuals and families may be severely compromised.

RECOMMENDATIONS: Programs for parents with mental illness and their families must be developed, driven by theory and research as well as funding source. Mechanisms need to be created that allow for interagency collaboration, and blended funding streams between adult and child mental health systems, and across the mental health, child welfare and other relevant systems. Programs for families in which a parent has a mental illness need to be described in theory and practice; and outcomes for adults and children need to be operationalized, and empirically assessed in both the short- and long-term. Strategies for program evaluation need to be developed and funded so programs can be tested and replicated effectively.

About the Author

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