Art as therapy: an effective way of promoting positive mental health?

The aim of this study is to evaluate the contribution that creative arts can play in promoting positive mental health and well-being. The research is based on a case study of an innovative art therapy programme delivered by a community-based mental health organisation in Northern Ireland, as part of a supported recovery programme. The study reported here explored the experiences and perceptions of the service users through in-depth interviews and focus groups. The art as therapy course was credited with improvements in self-esteem and self-confidence. It provided a safe space for reflection on mental health issues. Participants described the programme as cathartic and a springboard for engagement in a wide range of further projects. It is concluded that this type of project which addresses mental health issues in a supportive, positive, non-clinical environment can encourage and facilitate empowerment and recovery through accessible creative programmes. However, to date these programmes are time-limited, small-scale and marginal to the approach adopted by statutory service providers.     

The PALS parenting support programme: lessons learned from the evaluation of processes and outcomes

Although there has recently been a rise in parenting support programmes within the UK, only a minority of these programmes have benefited from evaluation of either outcomes or processes. This paper describes the development of the PALS programme (Parents Altogether Lending Support), reporting both on its effectiveness in improving parents' interactions with their children and on the lessons that were learned about embedding such a programme within the local community. Over the 18‐month period of the programme, a total of 17 courses were run, with 75 parents and carers (primarily mothers) participating in the programme overall. Evaluation results indicated that participants enjoyed the course and found it beneficial, particularly in terms of altering their own actions in specific ways that were able to promote better behaviour on the part of their children. Participants also valued the opportunity to share their experiences with other parents. The key lesson identified in regard to the development of parenting programmes concerned the need for the community to feel a sense of ownership for the initiative. Copyright © 2002 John Wiley & Sons, Ltd.     

Management of Night-Waking in Young Children

Regular waking at night is one of the most common problems encountered by parents of young children. In a family counselling programme in Auckland, a night-waking programme has been used with 208 children referred during a two year period. The programme involved organized bed-time routines, procedures for settling the child and non-reward of crying, calling out and getting out of bed. Programme introduction was followed by daily phone calls to parents in which appropriate parent behaviours were prompted and reinforced. Further face to face sessions were held after one week and then if needed. Parent reports show high rates of parent implementation of procedures and rapid change of child sleep behaviour with improvements being maintained at follow up. In a survey of 48 of the parents, positive changes in the daytime behaviour of children were reported as coinciding with improved sleep habits. Also there was an absence of negative side effects, and generally, parent satisfaction with the programme was high.     

The experiences of children living with and caring for parents with mental illness

This research provides a three‐way perspective on the experiences and needs of children who are living with and caring for parents with severe and enduring mental illness. The views of children, parents and key workers were sought in order to provide deeper insight into the needs of families and the nature of interfamilial relationships, as well as the relationships between service users and providers. Child protection and medical research has long proposed a link between parental mental illness and the risk to children of abuse, neglect and developmental delay. The inevitability of risk associations is challenged by the research described here and outcomes for children of caring for parents with mental illness are discussed not simply in terms of risk to children but more broadly in respect of, for example, positive parent–child relationships. Copyright © 2006 John Wiley & Sons, Ltd.     

Heterosexism,racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts. Implications for change advocates, mental health providers, and researchers are offered.     

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.     

Evaluation of the impact of the Webster‐Stratton Parent‐Child Videotape Series on participants in a Midlands town in 2001–2002

Small groups of parents experiencing problems in managing the behaviour of young children took part in parenting programmes in a Midlands city in 2001–2002 based on the Webster Stratton Parent‐Child Videotape Series. Programmes were evaluated using standardised measures and qualitative data. Most participants who completed the programme (N = 29) in this small scale study had improved scores on all measures. The largest (positive) effects were in reductions in mean total parenting stress levels. Qualitative data confirmed high participant ratings for the facilitators and appreciation for group support; and indicated that partners' views were an important variable. Further research is needed about programme impact on non‐completers (including fathers and minority ethnic participants) and about the influence of non‐participating partners.     

Outcomes of Parent–Child Interaction Therapy in an urban community clinic: A comparison of treatment completers and dropouts

This study examined outcomes of Parent–Child Interaction Therapy (PCIT) for 52 clinically referred children with oppositional behavior and their parents treated in an urban, community mental health clinic serving demographically (i.e., income level, ethnicity) diverse families. Standardized observations of parent–child interactions and parent reported measures of child behavior were collected at pre- and post-treatment. We addressed two primary research questions: (1) What are pre-treatment predictors of treatment completion? (2) What are treatment outcomes both for families who successfully completed PCIT and for treatment dropouts? Multiple logistic regression results showed a significantly greater likelihood of treatment completion related to higher parent education, male child gender, and two parent households. Among families who completed treatment, pre–post data demonstrated significant parent change in observed skill use and improvement in parent reported disruptive behaviors with medium to large effect sizes. Findings also documented early treatment benefits for families who completed the first phase of PCIT but dropped out in the final phase prior to meeting full graduation criteria. We discuss the findings and implications for community-based applications of PCIT in the context of community mental health's mission to provide effective treatment and maximize community access to services.     

Child sexual abuse: from prevention to self‐protection

There are a growing number of child abuse prevention and education programmes, including primarily group‐based parent and child education, which are taught by teachers within the school system. This article reviews some of the existing sexual abuse education and/or body safety programmes, as well as the research surrounding them. Advantages as well as criticisms of such programmes are reviewed. Issues such as target populations (i.e. children, teachers, parents), programme components and methodological limitations are addressed. Major findings include: children as young as three can be effectively taught self‐protection skills, parental and family involvement in training is important, and repeated exposure helps children maintain knowledge gains. The components of successful programmes include teaching children to identify and resist inappropriate touching, reassuring children that it is not their fault and learning the proper names of their genitals. Finally, future directions for programme development, research and policy are explored. Copyright © 2008 John Wiley & Sons, Ltd.     

Issues in the development of a computer-based safety programme for children with severe learning difficulties

In the last decade, professional interest in and awareness of the sexual abuse of children has increased dramatically and has led to the development of safety programmes which aim to teach children a range of personal safety skills (Tutty, 1992). These efforts have previously concentrated on children in mainstream schools, but there is growing recognition of the need for parallel concern for children in vulnerable groups such as those with learning difficulties. The present paper outlines the development of a personal safety prevention programme for children with severe learning difficulties. The programme has incorporated work by Tutty (1992, 1994) and others who argue for a more developmental view in designing such programmes. Concepts such as the child's understanding about authority figures and moral development have been integrated into the programme, which utilizes multi-media technology. As this is a computer-based programme, the reason for such a medium rather than previously implemented presentation (e.g. books, film) are discussed. Views of the participants evaluating the implementation of the teaching package are also described. © 1998 John Wiley & Sons, Ltd.     

Kinship Care for Children of a Parent With a Mental Illness

Little is known about “hidden” kinship caregivers of children of a parent with a mental illness (COPMI). An exploratory study surveyed 56 COPMI caregiver members of a kinship center administered by a school of social work in a large public university. The COPMI sample was a subset of a larger kinship caregiver study. Nearly one in four caregivers was providing COPMI kinship care. The COPMI caregivers reported numerous child behavioral crises and decreased caregiver physical and emotional health since they began providing care. Practice, policy, and research require development to increase support for COPMI caregivers and their families.     

Effects of a video feedback parent training program during child welfare visitation

Behavioral parent training programs have documented efficacy for improving behaviors among parents and their children and are frequently used by child welfare agencies to prevent removal of a child from the parental home or to facilitate reunification. Although an ideal time for parent training might be during supervised visits where parents may practice skills with their children under the guidance and support of a therapist or caseworker, this is not typically the case. Most often, parents within the child welfare system receive parent training in small groups without their children present, and to date, few studies have examined effects of behavioral parent training interventions during supervised visitation. In this study, concurrent multiple baseline across behaviors design was used to examine effects of a behavioral parent training program, Filming Interactions to Nurture Development (FIND), on parental skill acquisition with four mothers who had lost custody of their children but were being considered for reunification. Children emitted little or no problem behaviors during baseline or intervention, so parenting behavior was the primary dependent variable. Results obtained across participants documented a clear functional relation between implementation of the FIND intervention and increases in developmentally supportive parenting behaviors. Results of social validity and contextual fit measures suggest the intervention was perceived by mothers to be positive, feasible, and appropriate within the child welfare context. Practical and conceptual implications, limitations of this study, and directions for future research are discussed.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

Prevention of child sexual abuse: implications of programme evaluation research

Thirty child abuse prevention programme evaluation studies were selected according to a set of methodological criteria following an extensive manual and computer literature search. Targets for intervention in 17 studies were children; in three parents; in four teachers; and in six studies multisystemic programmes were evaluated where some combination of children, parents and teachers was targeted for intervention. From a review of the 30 studies, it was concluded that child abuse prevention programmes can lead to significant gains in children's, parents' and teachers' safety knowledge and skills. Best practice guidelines arising from the review include the use of multisystemic programmes; child‐focused curricula which cover a wide range of safety skills and concepts; and the use of didactic instruction and discussion, video modelling and active behavioural skills training techniques in programme delivery. The curricula for parents' and teachers' programmes should cover child protection issues and local child protection procedures along with an overview of the children's programme lesson plans. Longer programmes conducted by trained staff are preferable and such staff may include teachers, parents, mental health professionals and law enforcement officers. Copyright © 2000 John Wiley & Sons, Ltd.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Changing Relationships through Interactions: Preliminary Accounts of Parent–Child Interactions after Undertaking Individual Parent Training

Parent and child interaction training has been increasingly investigated over recent years. However, the mechanisms of change within individual training programmes are not well understood. To explore the factors that can facilitate or inhibit meaningful changes in interactions and ultimately relationships, the current study employed semi-structured interviews to obtain first person accounts from parents who had undertaken an individualised parent-training programme. Three participants provided accounts of the training programme and their perceived impact upon interactions with their children were analysed using inductive thematic analysis. The analysis resulted in three themes, which illustrate how participants adjusted their interactional style with their child to varying degrees through enhanced personal awareness, increased understanding of their child’s emotional and interactional needs, and accepting the reciprocity of interactional accountability. Changes in interactional style enabled participants to alter their perceptions of their own behaviours, their child’s behaviours, and how they influenced one another through interactions. Recommendations for future research and therapeutic practice are discussed in the context of the findings and the existing evidence base.     

Feasibility of Implementation of a Parenting Intervention with Karen Refugees Resettled from Burma

Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. This study tested the feasibility of implementing an adapted evidence‐based parenting intervention for contexts of trauma and relocation stress. Eleven Karen refugee caregivers from Burma participated in the intervention. Participants and a focal child completed ethnographic interviews as well as structured assessments at baseline and follow‐up. Caregivers reported changes in their teaching, directions, emotional regulation, discipline, and child compliance. Children reported changes in these areas and in positive parent involvement. Caregivers reported higher mental health distress immediately after the intervention, potentially due to increased awareness. Researchers made personalized referrals for counseling services as needed. Children reported a decrease in mental health symptoms.     

Outcomes of parental mental illness on children: a qualitative study from Iran

Children of parents with mental illness are a substantial, yet marginalized group. This study, as part of a more extensive research project, used grounded theory to explore the outcomes of parental mental illness on their children. Seventeen informants were interviewed at a mental hospital in the city of Qazvin, Iran. The participants were selected using purposeful and theoretical sampling. Interviews were analyzed using Strauss and Corbin's method. It was revealed that parental mental illness leads to five major outcomes that involve communication, mental, educational, economic, and extra roles factors. As such, it is suggested that these children should be considered within health care plans and that policy makers, nurses, and other health care providers use these findings for preventive and educational purposes.     

One Year On: Perceptions of the Lasting Benefits of Involvement in a Parenting Support Programme

The availability of parenting support programmes has increased significantly within the UK over the last decade. Most evaluations of these programmes have focused on short‐term outcomes. The present study attempted to gain a longer term perspective by interviewing 20 carers more than 12 months after completing a group‐based programme. The results obtained using thematic analysis showed that the majority of participants felt the programme had had lasting effects on their ability to manage their children's behaviour and empowered them as adults. The key themes to emerge in the interviews were: the maintenance of parenting skills, the need for perseverance, strengthening of support networks and encouragement for further provision of programmes. It is argued that evaluation of support programmes should focus on more than parenting skills by assessing their impact on participants’ wider lives.