14/7/131 SMILES PROGRAM INTRODUCTION & LONGITUDINAL FOLLOW UP Simplifying Mental Illness + Life...
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Transcript of 14/7/131 SMILES PROGRAM INTRODUCTION & LONGITUDINAL FOLLOW UP Simplifying Mental Illness + Life...
14/7/13 1
SMILES PROGRAM
INTRODUCTION & LONGITUDINAL
FOLLOW UPSimplifying Mental Illness + Life Enhancement
Skills
Created by Erica Pitman
14/7/13 2
ERICA PITMAN
• Registered Counsellor, Applied Social Science & Accredited Supervisor.
• Certificate IV Workplace Training & Certificatesof Management.
•Presented at over 70 conferences; developed/facilitated
over 144 workshops.• Extensive experience managing projects/programs,
Working alongside mental health & other services.
• SMILES Program Creator. Recognised asInternational Best Practice by American Journal of Orthopsychiatry, 2004.
• Deceased brother epilepsy & childhood schizophrenia.
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Internationally recognised as best practice
by the American Journal of Orthopsychiatry
(Accepted Apr 2003, Published July 2004,
Vol 74, Issue 3).
SMILES
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• Developed 1997 by Erica Pitman
• Children in families affected by mental illness ‘at
risk’ developing own mental health problems
• 8-12 or 13-16 yrs, with parent or sibling with a
mental illness
• 8-10 young carers in a program
• 3 day program best suited to school holidays
• Recommend delivery in partnership with local
service (eg. child & adolescent or mental health
team)
OVERVIEW
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PARTICIPATION
1998-2009170 Children
Bathurst x2
Bankstown
Canley Vale x2
Central Coast x2
Fairfield
Orange
Parkes
Parramatta
Pointe-Claire,Montreal,
Canada
Average Age = 10 yrs
Cowra
Wagga Wagga
Chatswood
Cronulla
Dubbo Harrington Park
Penrith
Seven HillsTamworthWollongong
Kitchener,Ontario, Canada
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• Improves capacity to cope more
effectively
• Increases resiliency
• Improves self-expression & creativity
• Increases self-esteem
• Reduces feelings of isolation
AIMS
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CONTENTS
• Age-appropriate education about mental
illness
• Life skills training -• Communication exercises• Problem solving• Art work & music• Interactive & relaxation exercises• Peer support
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EVALUATION
0
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8
Knowledge (/10)
Question #
Knowledge 'Mean' Scores Combined (Fairfield, Orange, Canada)
Pre
Post
Pre 3.68 2.47 2.25 1.57 4.83 4.29 1.78 1.30 3.56
Post 7.63 5.94 6.75 5.71 7.08 7.53 6.56 5.50 7.06
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Combined pre & post knowledge mean scores for 25 participants Australia & Canada. Average age 10.8 yrs
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EVALUATION
Combined pre & post life skills mean scores for 25 participants Australia & Canada. Average age 10.8 yrs
0
1
2
3
4
5
6
7
8
9
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Skill Rating (/10)
Question #
Life Skills 'Mean' Scores Combined (Fairfield, Orange, Canada)
Pre
Post
Pre 6.61 7.17 7.72 4.00 6.67 7.94 5.44 6.22 6.78 9.17
Post 8.28 8.33 9.44 6.06 8.39 9.17 7.44 7.78 8.44 9.89
Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19
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EVALUATION
Combined pre & post knowledge mean scores for 23 participants Bathurst, Parkes, Canley Vale (Carers NSW Mental Health Project, Stage 1). Av age 10.2yrs
Figure 20. Self-reported Pre- and Post-Program Knowledge Questions (N=23)
0
1
2
3
4
5
6
7
8
9
10
mental illness causes ofmental illness
schizophrenia signs ofschizophrenia
depression signs ofdepression
bipolardisorder
signs ofbipolar
treatments
pre
post
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EVALUATION
Combined pre & post life skills mean scores for 23 participants Bathurst, Parkes, Canley Vale (Carers NSW Mental Health Project, Stage 1). Av age 10.2yrsFigure 21. Self reported Pre- and Post-Ratings of Life Skills (N=23)
1
2
3
4
5
6
7
8
9
10
talk withother
people
listen toother
people
express"OK"
feelings
express"yucky"
feelings
recognisemy
strengths
becreative
solveproblems
relax feel goodaboutmyself
have fun
pre
post
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EVALUATION
Comments from participants:
• “I am not the only one who has a family member who is
sick. It’s not Dad’s fault.”• “It was fun doing the card and drawing.”• “I liked the games and meeting new people.”• “I learnt that mental illness can’t be caught like a cold.
And people with schizophrenia can hear things and see things that aren’t real.”
• "I have told other children who don't know what they are
talking about what depression really means.”• "I learnt a lot about problem solving at home.”• "I learnt that it's (mental illness) not our fault.”• "It was good because now I can express my feelings more
- thanks!”
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EVALUATION
Comments from parents of the participants:
• "The program gave the children a real insight into the hows and whys
of depression at a level they could understand.”• "(My son) has a less frustrated attitude at what I can't do.”• "The program has also given to this family, a sense of belonging
without pre-judgement.”• "This is the first time we've been able to discuss mental illness as a
family.”• "(My daughter learnt) how to deal with her emotions/feelings more
effectively.”• "We have started understanding each other in many different ways.”• "More understanding of her sister's difficulties and how normal it is to
become frustrated at her and our life.”
14/7/13 15
LONGITUDINAL FOLLOW-UP
• Response rate 66% (Children participated
CNSW MH
Project from MW & SWS regions).
• Rural - Bathurst x2, 2003 & 04 (1 MWAHS
funded)
• Remote - Parkes, 2004
• Metro - Canley Vale x2, 2004 & 05
Table 1. Participation in SMILES and in the Follow-Up
Region # Participants # Follow-Ups % Followed-Up
Rural 18 11 61.1
Remote 7 3 42.9
Metro 13 11 84.6
Total 38 25 65.8
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 16
LONGITUDINAL FOLLOW-UP
• Follow-up interviews conducted 6-10mths after
program
completed.
• Face to face interviews taped. Conducted by MW
C&A staff
and CNSW Young Carer Project Officers.
• Parents completed questionnaire while children
interviewed.
• 72% girls.
• 96% parent mental illness (could have both parent & sibling).
• 20% sibling with mental illness.
• 40% older than 12yrs at time of follow-up.
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 17
LONGITUDINAL FOLLOW-UP
Table 2. Changes in Circumstances
Type of Change % Experiencing Examples of Changes
Changed schools 20.0 high school moved house – had to change
schools
Moved house 25.0 we moved into our auntie’s house old house was getting knocked down
Householdcomposition
33.3 aunt & uncle & pop moved in sister (with mental illness)
occasionally lives with us father moved back into home
Other changes 29.2 mother now pregnant changed years at school
N 24
• Up to 1/3 underwent potentially stressful changes
• 43% witnessed episode of person with m.i. being unwell
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 18
LONGITUDINAL FOLLOW-UP
Table 3. Children’s Perceptions of what SMILES was Like
Category Examples
Peer support Fun, making new friends Really nice workers, friends, meeting new people
Knowledge Learn more about illness Activities learning about illness & depression
Games/social
interaction
Play games, game where people say nice things about you Played soccer in big groups
Respite Good to meet new people & get out of the house Fun, let us have a break
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 19
LONGITUDINAL FOLLOW-UP
• 88% recalled positively. Able to recall some of what
they
did & learned (even after at least 6mths).
• Majority able to recall some basic facts about m.i.,
not
always with clarity.
• Recall what m.i. is & they weren’t to blame for it.
• Less able to recall causes (these are complex) &
treatments.
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 20
LONGITUDINAL FOLLOW-UP
Table 4. What Children Worry About
Category Examples
Abandonment What I’d do without her. I don’t want her to go to hospital She’ll move away or might die
That the personwill hurtthemselves
If she does anything silly or dangerous. Stabbing herself with knife acouple of times
Mum might get hurt. The medicine makes her sleepy I worry that my mum might kill herself
Impact on theconsumer
How they are and how they are coping
Anticipation offurther episodes
I see her so well but I know that she can get sick I worry she’s going to chuck a mental when we come to visit her
Stopping ofmedication
Not taking tablets – Mum and Dad fight when that happens
Police involvement Doing drugs. Getting caught by police, gets into trouble, She’ll lose allher friends.
• 52% worry a little, 40% worry a lot about person with m. i.
• 98% talk with someone (usually family, also counsellors, friends, Kids
Helpline).Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 21
LONGITUDINAL FOLLOW-UP
Changes in Comfort Discussing Mental Illness
87% children more comfortable talking about
mental illness - examples:
• SMILES gave them more understanding so they
felt more
confident discussing it
• SMILES encouraged them to open up more about
feelings
- “usually worried to get it out. Now it’s fine.”
• Realisation not the only ones with mental illness
in family
made it easier to raise the issue
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 22
LONGITUDINAL FOLLOW-UP
Changes in Ways of Coping During Crisis
• 60% dealt with situations differently after SMILES
When asked what was different this time, children
responded:
• “asked for counselling”
• “I can cope better. I’m not the only one.”
• “I knew what she was doing and why”
• “I used to stay and try to help him stop - but best not
to
because he pushes me down”
• “wasn’t afraid to comfort her”
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 23
LONGITUDINAL FOLLOW-UP
Table 5. Ways in which Children Felt SMILES Helped
Category Examples
General knowledgeor understanding
A little bit. Getting to know more about dad’s mental illness and otherpeople’s mental illness
Because when I first went I didn’t know anything about mum’sdisability
Explained mental illness to us. Kids Helpline Number Teach me stuff I didn’t know before. How to handle mental illness,
what to doEncouragedcommunication
Can talk to mum a lot more. In being able to communicate with others and telling them how I feel
Social/peer support Making friendsSelf esteem Good tips on how to think of yourself as a good person. boosted self
esteem SMILES kept my self esteem up
96% felt SMILES helped them
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 24
LONGITUDINAL FOLLOW-UP
Support After SMILES
• 36% attended a Young Carer Camp
• 42% spoke with a counsellor/doctor
• Nil accessed Internet re Young Carer
information
• Peer support during program important
aspect,
however difficult to maintain after without
structured programs or follow-ups.Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-
up Report
14/7/13 25
LONGITUDINAL FOLLOW-UP
Parent/Guardian Perspective
• 52% sited children coping better
• Understanding gained was invaluable
• 83% felt child more able to talk with them
• 86% parents felt more confident & comfortable
talking with
child about m.i.
• Parents felt key elements - peer support & greater
understanding of m.i.
• 100% felt SMILES helped (initial evaluation 100%
would
recommend to other families)
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 26
LONGITUDINAL FOLLOW-UP
Conclusion• Reinforced positive findings from short-term evaluation.
• Congruence between children’s & parent’s feedback increases
confidence
in findings.
• Gained information & skills to respond differently. Absorbed
lessons &
applied them. Illustrates that having an understanding of
what is happening can be critically important.
• Remembered SMILES as fun & informative.
• Improved communication about m.i. within families.
• On-going reinforcement of knowledge important (after
program).
• Peer support valuable, however not able to be maintained(need
for services
to structure follow-up).
Pagnini, D. 2007, Carers NSW Carers Mental Health Project (2001-2004) Longitudinal Follow-up Report
14/7/13 28
Erica PitmanCounsellor, Supervisor, Group Facilitator,
Funeral CelebrantAdv Dip App Soc Sc, CMCAPA, RMPACFA, MFCAAARCAP Registered, PACFA Accredited Supervisor
P O Box 9139 Bathurst, NSW 2795
Ph: (61 2) 6332 9498 Email: [email protected]
ABN: 93 238 981 967