FORGOTTEN CHILDREN: WHICH PROBLEMS WITH THE FIRST ITALIAN EXPERIENCE?

XI WAPR World Congress Milano 10-13 november 2012

I. Brusa , A.Cerri, E.Re, F.Tasselli

WHY PREVENTION?

PREVENTION IS MORE EFFECTIVE AND ECONOMIC

THAN WAITING AND TREATING PSYCHOLOGICAL

PROBLEMS OF THE CHILDREN WHEN THEY APPEAR

Shochet et al 2001

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THE ILL PARENT is absorbed by his thought and emotions : can’t put attention to people around him

“I don’t know to do with the baby”, “I can’t do anything” : feeling of inadequacy

“before I was fine, he’s the cause of my problems”, “he scares me” : feeling of the baby as a problem for him “all is ok “, “all is going worse” : loss of the critic, he’s hypo o hypercritic

THE CHILD

“mom doesn’t care me because I’m bad” : feeling of guilty “I don’t know what I’ve to do”, “I can do it by myself”: feeling of impotence or omnipotence “these homework are necessary, if I don’t do them,

nobody does” : he charge himself of too much responsibility “I’ve to protect my mom “, “ I must keep the secret” : he develops two identity levels

Children experience can include I’m the cause of the problems, and my father doesn’t love

me anymore

if I were different , all could be better

I hate my parents !

Parent experience can include I’m not good father/mother

If I were not here, all could go better

How many trioubles with the children !

Professional experience can include Poor child ! what kind of parents !! My little patients have not to suffer cause the parents !

Tytti Solantaus, 2010

“LITTLE FLOWERS IN SESTO” (PICCOLI FIORI IN SESTO)

starting from Adult Mental Health System

a pilot project took place from 2010 to 2011

in Milano by NGO “Contatto Onlus ”, in partnership with Adult and Child Mental Health Services of Sesto S.Giovanni

6-14 y.o. children of adults treated by the local adult CMCH

The aim : to evaluate and increase protective factors and the relationships in and out of the family, using a natural social networks activation approach

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EXPECTED RESULTS AND OUTCOMES ACHIEVED:

In the Sesto San Giovanni CMCH: 26.4% of patients between 25 and 55 years

old, (A.V. 97) had children under 18, so we expected to be able to include a high number of families.

On the contrary we received from the service just 16 referrals and we were able to treat just 6 families.

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Professionals referred onlyhigh pathological families

We couldn’t work following a perspective of prevention

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THIS RESULT WAS PROBABLY THE EFFECT OF CULTURE OF CARE IN MENTAL HEALTH SERVICES: the focus on the adult patient picked out

from his environment the attitude to consider some patient abilities

(like occupational or domestic skills), neglecting parental competences the fear of stigmatizing the patient the supposed risk of interference in the

therapeutic relationship the offer of the program was focused on the

child social network and not addressed to the whole family Ass CONTATTO

Onlus Milano

MOREOVER:

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After a specific training and after going deeply in the literature, we conceived a new preventive project, that will take place in 2013 and 2014

It will be realized in Milano by Contatto Onlus”, in partnership with Adult Mental Health Services of Niguarda Ca’ Granda and San Carlo Hospitals and La Tartavela, association of family members.

it is funded by the Municipality of Milan

THE PROGRAM HAS BEEN REFOCUSED AND RESHAPED IN ORDER:

to extent the intervention to the whole family

to extend the recruitment to a larger population

we agreed with CMHC professionals a strict procedure in order to cooperate to recruit all the recruitable families, keeping the difference between CMHC professionals and the special team in terms of competence and roles

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APPROACH

We will follow the Finnish approach of T.Solantaus (Let’s Talk intervention, Family Talk Intervention, Vertti Group)

We will also maintain our traditional intervention

on the natural social network of the child

We involve family member associations , but for the moment we choose not to formally involve

other services or the general population

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FLOW CHART – SEMOLA PROGRAM

FIRST NURSE INTERVIEW

FIRST INTERVIEW(PSYCHIATRIST W COWORKER) 

c

LET’S TALK (1 - 3 sessions )(CW WITH A TRAINED PSYCHOLOGIST)

No other intervention 

FAMILY TALK INTERVENTION 

VERTTI GROUP 

NATURAL SOCIAL NETWORK ACTIVATION 

TARGET:Every new patient with children 6-

14

TENDENCIES AND PROBLEMS OF SERVICES …IGNORANCE, FEAR, ABSTINENCE !!!

not to consider children problems fear to stigmatize their patient as bad parent fear to ruin the relationship with the pt to consider this problem not as a

competence of adult psychiatry, but of infant psychiatry

formally correct, but altogether inadequate cooperation among services involved (health/social, adult/infant, hospital/clinics)

weak services system governance and no mandatory preventive programs by health local authority or health/welfare ministry

TOWARD A MULTILEVEL AND MULTITASK INTERVENTIONmentally ill person symptoms

abilitiestherapyrehabilitation

parental couple relational dynamicsparental competences

family therapyparentood education

family at large relational dynamicsinterpersonal communicationsocio-economical conditions

therapypsychoeducationsocila support

child living with psychological frialtyrelational problemsmaterial problemsschool performance

support to the resiliencesupport to the social networklearning support

school contest and neighbourood

stigmamarginalization

information campaignsinclusive actions

general culture and social capital

stigmamarginalization

information campaignsinclusive actions(newspapers, radio etc)

Stop thinking that talking about problems could be dangerous !!

TALKING ABOUT PROBLEMS LET PEOPLE BE BETTER !!!!

Don’t wait !!

TO PREVENT IS BETTER THAN TO TREAT !!!!