Psychiatric Rehabilitation Journal 2014, Vol. 37, No. 3, 183–185
© 2014 American Psychological Association 1095-158X/14/$12.00 DOI: 10.1037/prj0000071
Mental Health Consumer Parents’ Recommendations for Designing Psychoeducation Interventions for Their Minor Children Joanne Riebschleger and Esther Onaga
Betty Tableman
Michigan State University
Michigan State University and Michigan Department of Mental Health, Lansing, Michigan
Deborah Bybee This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Michigan State University Objective: This research explores consumer parents’ recommendations for developing psychoeducation programs for their minor children. Method: Data were drawn from a purposive sample of 3 focus groups of parent consumers of a community mental health agency. The research question was: “What do consumer parents recommend for developing psychoeducation programs for their minor children?” Results: Parents recommended content foci of mental illness, recovery, heritability, stigma, and coping. Conclusions and Implications for Practice: The next step is youth psychoeducation intervention development and evaluation. Parents, youth, and professionals should be included in the program planning. Keywords: mental illness, mental health, parent, child, psychoeducation
“What do consumer parents recommend for developing psychoeducation programs for their minor children?”
England and Sim (2009) examined health databases to find 15 million American children with a parent with a mental illness. These children often have insufficient information about mental illness, recovery, and coping (Cowling & Garrett, 2008; Mordoch & Hall, 2008). Children of a parent with a mental illness can benefit from information about parental mental illness and recovery (American Academy of Child & Adolescent Psychiatry, 2000; Riley et al., 2008) in groups with children from similar families (Pitman & Matthey, 2004). The groups combine education with social support (Cowling, 2004) similar to evidence-based adult multifamily group psychoeducation (Östman & Hannson, 2009).
Procedures Community mental health professionals approached consumer parents about their interest about participating in the study. Parents completed consents for research and demographic forms. Professionals provided information about parents’ mental health, substance use, physical health, and Global Assessment of Functioning score (GAF; American Psychiatric Association, 2000). The university Institutional Review Board required a GAF score of 41 or higher for parent consent. Researchers with mental health practice experience facilitated three focus groups. The facilitator probed for clarification for ambiguous answers (Krueger & Casey, 2009). Near the end of each group, the facilitator “checked-in” with participants to ensure data reflected participants’ meanings (Krueger & Casey, 2009). Data were triangulated using transcriptions of audio-taped focus groups, research assistant and facilitator field notes, and facilitators’ postgroup debriefings.
Method Effective program development involves key stakeholders, including consumer parents (Conyne, 2010; Jenson & Hoagwood, 2008). This study used a purposive sample of parents receiving community mental health services. The research question was:
This article was published Online First May 12, 2014. Joanne Riebschleger, Associate Professor, School of Social Work, Michigan State University; Esther Onaga, Associate Professor, Department of Human Development and Family Studies, Michigan State University; Betty Tableman, Emeritus, Specialist, Department of Community Outreach and Engagement, Michigan State University, and, Retired, Prevention Services Director, Michigan Department of Mental Health, Lansing, Michigan; Deborah Bybee, Professor, Department of Psychology, Michigan State University. Correspondence concerning this article should be addressed to Joanne Riebschleger, PhD, LMSW, Associate Professor, School of Social Work, Michigan State University, 655 Auditorium Road, 108 Baker Hall, East Lansing, MI 48824. E-mail:
[email protected]
Data Analysis The analyses used a conventional content analysis approach (Hsieh & Shannon, 2005). Data were coded in participants’ language, while searching for convergent and divergent data (Saldaña, 2009). The research team achieved consensus about independently coded data analysis with subsequent group discussion across stages of coding for initial themes and subthemes, followed by coding data to themes (Braun & Clark, 2006; Saldaña, 2009). Findings reflected data from all three groups. Interrater reliability of coding to operationally defined themes/subthemes was 81.1%. 183
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Sample Eleven consumer parents, ages 29 – 44, participated in three focus groups. The mean age was 36.30 (SD ⫽ 4.50). Eight were female, nine Caucasian, and one Latino. The mean income was $11,290 (SD ⫽ 4,660), from disability checks (seven), employment full-time (two), and part-time (one). One was looking for work. Parents had mental health diagnoses of: major depression (four), schizoaffective disorder (two), bipolar disorder (three), posttraumatic stress disorder (one), and schizophrenia (one). Four had no alcohol/drug problems, five had a history but no current use, and one was reported to be abusing alcohol currently. GAF scores ranged from 42 to 53 (x ⫽ 49.20, SD ⫽ 4.64), indicating serious mental illness (APA, 2000). Parents reported caring for 34 children, aged 11 months to 17 years (Mean: 3.4; SD ⫽ 2.50). Nineteen minor children were female (56%). Consumer parents identified their roles as birth mother (n ⫽ 22), birth father (n ⫽ 3), stepmother (n ⫽ 5), and stepfather (n ⫽ 4). Parents reported having full custody (n ⫽ 19), shared custody (n ⫽ 7), legal guardianship (n ⫽ 2), and no legal status for their partner’s children (n ⫽ 6). Eight were single parents.
Results: Parents’ Recommendations for Youth Psychoeducation Content
medication, the appropriate treatment plan, you can have a happy life.” One said children should know that “mental illness ain’t necessarily a scary thing.” Most described the importance of taking medications as part of recovery but said this needed to be separated from using drugs “to get high.” One said the youth should learn about co-occurring disorders because “substance abuse and depression can be a catalyst to each other.” Several parents emphasized teaching children how to interact when parents are “doing well” or poorly. Several suggested presenting the “positives” of mental illness, for example, enhanced “creativity.”
Heritability Parents noted that the youth needed to learn that their genetic risks for acquiring a mental illness were higher than youth who do not have a parent with a mental illness, but there is room for “cautious optimism.” One said, “Just because I have it [mental illness], doesn’t mean the kids are going to have it.” Most said they wanted their children to know that even if they acquire a mental illness they can be successful: . . . you got brain surgeons that have bipolar disorder. You have lawyers that are bipolar . . . they can still be successful, they still could become brain surgeons, they still can become lawyers . . . or whatever they want to become.
Parents recommended program content about mental illness, recovery, heritability, stigma, and coping. Quotations below are the words of the parents.
Some articulated they wanted their children to know “when to ask for help” should symptoms develop/worsen.
Mental Illness
Stigma
Parents recommended their children learn about mental illness and recovery. All but one supported participation in youth psychoeducation groups. The dissenting parent sought a family recreational format. A mother explained, “It might make them feel better to know there’s other kids out there that are going through the same things they’re going through . . . There might be some good friendships coming out of it.” Another parent agreed, “If they’re [youth] are not explained or educated [about mental illness], they don’t understand.” All parents adamantly declared that they wanted their children to know that mental illness is an illness:
Most parents relayed descriptions of mental illness-related stigma experiences “people thinking I’m stupid,” and “people looking down on me.” One expressed, “There’s something wrong with me . . . [I’m] not a bad person.” They said children may be “embarrassed or feel ashamed” of the parent’s mental illness. One said she thought it was important to teach youth about inaccurate stigmatized beliefs and behaviors and “how to respond to stigma” situations.
It’s like any disease . . . if you have kidney disease, and you have to have dialysis, you do. If you have something wrong with your brain, and it doesn’t release the right chemicals in the right amounts, you have an imbalance.
Most parents strongly emphasized psychoeducation should focus on youth coping, “Definitely teach them coping skills.” They listed specific coping behaviors, that is, “exercise,” “Yantra,” “hobbies,” “thinking positive,” and “talking to someone.” They wanted their children to learn how to talk to the parent about the mental illness symptoms and “when to help me” and when to “ just go play.” Most parents noted that children’s learning, including increasing coping skills, were likely to be enhanced with a program curriculum that includes age-appropriate content, “I wouldn’t tell my 16-year-old the same thing I tell my 11-year-old,” a parent explained. The parents also said that getting their children to participate in the program would require active learning activities, that is, “crafts,” “music,” “games,” “videos,” “role plays,” “skits,” and “sports.” They said “food” and incentives “. . . prizes or money . . . are essential” for motivating attendance.
One mother was more specific: “Teach the kids, um, all the information they can about the symptoms, and how it affects them and how the medications affect the parent.” Many parents emphasized that their children need to learn that mental illness symptoms are common, that is, “. . . there are a lot of famous people with mental illness.”
Recovery Parents wanted the youth to learn that mental illness symptoms can often be managed with active recovery, for example, “You gotta work at it [recovery].” Another agreed, “If you follow the
Coping
MENTAL HEALTH CONSUMER PARENTS
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Conclusions and Implications for Practice The next step is to develop and test a youth psychoeducation program, preferably with a control/comparison group. A program manual should be developed with input from youth, parents, and professionals. Outcome measures for youth-reported knowledge of mental illness recovery, stigma, and youth coping should be assessed at pre-, post-, and follow-up intervals. It is recommended that mental health services revise their policies and procedures to include parenting within consumeroriented planning. For example, mental health professionals can begin by asking adult consumers questions at intake: “Do you have any children?” “What are their ages?” “Do they live with you?” in order to focus attention on the relevance of children to the client’s life and functioning. The study limitations include a nonrandomized, small sample. Information provided was not verified by others. However, given how little is known about consumer parents’ perspectives about their children’s mental illness information needs, the focus group methods seem appropriate for early knowledge development. Most critically, consumer parents offered valuable services planning recommendations which can contribute to the future development and testing of evidence-based psychoeducation programs for children who have a parent with a mental illness.
References American Academy of Child & Adolescent Psychiatry. (2000). Children of parents with mental illness. Retrieved from www.aacap.org/publications/ factsFam/PARENTMI.HTM American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text revised). Washington, DC: American Psychiatric Association. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–102. doi:10.1191/ 1478088706qp063oa Conyne, R. K. (2010). Prevention program development and evaluation: An incidence reduction, culturally relevant approach. Thousand Oaks, CA: Sage. doi:10.4135/9781483349176
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Cowling, V. (Ed.). (2004). Children of Parents with Mental Illness 2: Personal and Clinical Perspectives. Melbourne: Australian Council for Educational Research. Cowling, V., & Garrett, M. (2008). Children of parents with mental illness and their family relationships. COPMI GEMS, 3, 1–3. Retrieved from http://www.copmi.net.au/images/pdf/Research/gems-ed.-3-december2008.pdf England, M. J., & Sim, L. J. (Eds.). (2009). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention. Washington, DC: National Research Council and Institute of Medicine of the National Academy of Science. National Academies Press. Hsieh, H., & Shannon, S. E. (2005). Three approaches to qualitative analysis. Qualitative Health Research, 15, 1277–1288. doi:10.1177/ 1049732305276687 Jenson, P. S., & Hoagwood, K. E. (Ed.). (2008). Improving children’s mental health through parent empowerment: A guide to assisting families. New York, NY: Oxford Press. Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks, CA: Sage. Mordoch, E., & Hall, W. A. (2008). Children’s perceptions of living with a parent with mental illness: Finding the rhythm and maintaining the frame. Qualitative Health Research, 18, 1127–1144. doi:10.1177/ 1049732308320775 Östman, M., & Hannson, L. (2002). Children in families with a severely mentally ill member: Prevalence and need for support. Social Psychiatric and Psychiatric Epidemiology, 37, 241–248. doi:10.1007/s00127002-0540-0 Pitman, E., & Matthey, S. (2004). The SMILES program: A group program for children with mentally ill parents or siblings. American Journal of Orthopsychiatry, 74, 383–388. doi:10.1037/0002-9432.74.3.383 Riley, A. W., Valdez, C. R., Barrueco, S., Mills, C., Beardslee, W., Sandler, I., & Rawal, P. (2008). Development of a family-based program to reduce risk and promote resiliency among families affected by maternal depression: Theoretical basis and program description. Clinical Child and Family Review, 11, 12–29. doi:10.1007/s10567-008-0030-3 Saldaña, J. (2009). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage.
Received October 28, 2013 Revision received March 9, 2014 Accepted March 17, 2014 䡲
