Parenting with a Mental Illness UP ENN C OLLABORATIVE ON C OMMUNITY I NTEGRATION OF I NDIVIDUALS WITH D ISABILITIES presents Parenting with a Mental Illness.

UPENN COLLABORATIVE ON COMMUNITY INTEGRATION OF

INDIVIDUALS WITH DISABILITIES

presents

Parenting with a Mental Parenting with a Mental IllnessIllness

An Innovative Teleconference Co-sponsored by Mental Health

America

May 9, 2007UPENN COLLABORATIVE

ON

COMMUNITY

INTEGRATION

After the Teleconference,please visit our web site at

www.upennrrtc.org

Parenting with a Mental Parenting with a Mental IllnessIllness

Teleconference Presenters

Katy Kaplan, M.S.Ed.(moderator)

Joanne Nicholson, Ph.D.

Rebekah Leon, BA, C.S.W.

Edie Mannion, M.F.T.

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

Please Note:

The Teleconference Presenters have generously made their PowerPoint presenta-tions available on this web site. Any information used from these presentations must be cited, and proper credit given to the author.

Thank you!

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

Parenting with a Mental Parenting with a Mental IllnessIllness

TeleconferenceTeleconference

Presenter

Joanne NicholsonJoanne Nicholson, Ph.D., Ph.D.

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

Creating Options for Families

Joanne Nicholson, Ph.D.Center for Mental Health Services

ResearchUniversity of Massachusetts Medical

SchoolWorcester, Massachusetts, USA

[email protected]

www.parentingwell.orgMay 9, 2007

Toni Wolf, Executive Toni Wolf, Executive DirectorDirector

82 Brigham Street Marlborough, Massachusetts

01752 USA508-485-5051

[email protected]

Who We Are at UMMS:Who We Are at UMMS:

Multidisciplinary group: psychology, occupational therapy, public policy, mental health law, rehabilitationResearchers, clinicians, advocates, family membersParents with mental illnessStrategic Planning Group

EO, Inc. Mission Statement:EO, Inc. Mission Statement:Through inspiration, Through inspiration, support & encouragement, support & encouragement, Employment Options Employment Options creates a home-away-from-creates a home-away-from-home, where people can home, where people can overcome barriers to overcome barriers to employment and discover employment and discover personal growth, self-personal growth, self-sufficiency, and hope.sufficiency, and hope.

Our PartnershipOur Partnership

1995 –UMMS focus group at EO

Members started talkingToni started listeningFamily Project began

1996 – DMH supported housing contract for services for 7 families

First StepsFirst Steps

Identified parents in clubBegan to identify needs

Christmas presentsSuggestions for visits

Held holiday party

The (original) Family The (original) Family ProjectProject

DMH supported housing contractParent is “identified client”Need for DMH eligibility

Difficult to obtainRequires major functional impairment(s)

Our Partnership (cont’d.)Our Partnership (cont’d.)1997 – NIDRR-funded

Parenting Options Project Regional Clubhouse Parenting ConsortiumParentLink NewsletterParent Work Groups“Parenting Well When You’re Depressed”

Family Project Family Project DevelopmentsDevelopments

Supervised visitationHome visitsCollateral contacts

Crisis on-callSocial activitiesAdvocacy for children

Lessons LearnedLessons LearnedFocus on entire families“Warm line” vs. crisis on-callAggressive care management Respite servicesFlexible fundsKnowledge of adult, child & family systems“Messy” legal issuesLong-term involvement optimal

Our Partnership (cont’d.)Our Partnership (cont’d.)

1999 – Clubhouse Family Legal Support Project (CFLSP)

NAPIL funding2002 – DMH funding2003 – Massachusetts Bar Foundation funding

Clubhouse FamilyClubhouse FamilyLegal Support ProjectLegal Support ProjectConsultation to adults re: custody & family situationsDirect representationAttorney at Mental Health Legal Advisors Committee in BostonAttorney, parents & clubhouse advocate work together

Our Partnership (cont’d.)Our Partnership (cont’d.)2002 – SAMHSA-funded

“Strengthening Families” Community Action Grant

Develop consensus re: families’ needsConsider feasibility of models like Invisible Children’s Project (ICP)

Activities of SAMHSA-fundedActivities of SAMHSA-fundedStrengthening Families ProjectStrengthening Families Project

Stakeholders recruitedChampions createdData re: needs collectedCommunity resources identifiedRelevant model (ICP) examinedAgreement to adapt & implement family model achieved

Outcomes of SAMHSA-funded Outcomes of SAMHSA-funded Strengthening Families ProjectStrengthening Families Project

Concept paperAdvocacy planExploration of funding alternativesDevelopment of key stakeholder relationshipsProposed model

Strategic Relationships Strategic Relationships FormedFormed

MA Dept. of Social ServicesMA Dept. of Mental Health – children’s servicesMBHP – Medicaid MCOFamily Network (early childhood)

CMHCsClinicsHomeless Services Boys & Girls’ ClubsEarly Intervention Local hospitalsParents

Family OptionsFamily Options

“Building resources and relationships to promote resilience and recovery in

parents with mental illness and their children”

Intervention InnovationIntervention InnovationInvolves entire family, including children of all ages (<18) who may or may not have “problems”Draws from what we know about evidence-based practice for adults with mental illness & parentingBuilds on what we have learned works best in a clubhouse settingRequires shifting agency focus

Theoretical FoundationTheoretical FoundationPsych rehab (e.g., Nicholson & Henry, 2004)Attachment theory (Mahler et al.)Self-efficacy theory (Bandura et al.)Motivation/behavior change theory (Miller et al.)Strengths case management (Rapp et al.)Wraparound model (SOC)Resilience/developmental assets (Search Institute)

Family Options Key Family Options Key ConceptsConcepts

Family-centeredStrengths-basedFamily-driven & self-determinedRecovery & resilience

Family Options Key Family Options Key ProcessesProcesses

Engagement & relationship buildingEmpowermentAvailability & accessLiaison & advocacy

Family Options TeamFamily Options TeamSupervisor & 3 Family CoachesClinical ConsultantProvide:

Intensive outreachStrengths assessment & goal setting24-hour availabilityFlexible fundsLiaison & advocacy

Family Options OutcomesFamily Options OutcomesParent & Child

Well-beingFunctioningSupports & Resources

FamilyEmpowermentSupports & Resources

Implementation StudyImplementation Study

Study process of implementing Family OptionsExamine impact of required paradigm shift within agency from focus on individual adults to families

Challenges to Challenges to Implementation – Program Implementation – Program LevelLevelStaffing, hiring, and trainingActualizing innovative conceptsWorking with complex familiesAllocating scarce resources

Challenges to Challenges to Implementation – Agency Implementation – Agency LevelLevel

“Integration” of new program in existing agencySustainability“We didn’t anticipate…..”

Challenges to Challenges to Implementation – Implementation – Community LevelCommunity Level

Nurturing and educating community partnersIdentifying suitable community resources

RespiteHousing

““I think my children had I think my children had difficult experiences being difficult experiences being raised by a mother with mental raised by a mother with mental illness. I’m not going to illness. I’m not going to pretend that it’s all been easy. pretend that it’s all been easy. But there isn’t anything that But there isn’t anything that we experience that doesn’t we experience that doesn’t come with some blessing. And come with some blessing. And I think there has been I think there has been blessing, even in the hard blessing, even in the hard stuff.”stuff.” -Mother of two, living with mental illness -Mother of two, living with mental illness

Parenting with a Mental Parenting with a Mental IllnessIllness

TeleconferenceTeleconference

Presenter

Rebekah Leon, B.A., C.S.W.

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

The Consumer Parent Support The Consumer Parent Support Network; A Comprehensive New Network; A Comprehensive New

Jersey ProgramJersey Program

Presenter: Presenter: Rebekah Leon, BA, C.S.W.Rebekah Leon, BA, C.S.W.

How to Support Parents with aHow to Support Parents with a Mental Illness Mental Illness

Wednesday, May 9, 2007

The Consumer Parent Support Network: a Successful Program for Parents Coping With Mental Illness and Their Children

The purpose of the Consumer The purpose of the Consumer Parent Support Network is to Parent Support Network is to support parents with a diagnosis of support parents with a diagnosis of mental illness in their parenting mental illness in their parenting efforts and to promote the healthy efforts and to promote the healthy functioning of the family unit.functioning of the family unit.

Learning ObjectivesLearning Objectives

At the end of this presentation the participant should be able to:

• Identify challenges specific to parents with mental illness

• Recognize risk factors associated with untreated parental mental illness

• Understand the Consumer Parent Support Network Program

We know a great deal about We know a great deal about children from studies:children from studies:

• Children whose parents have a mental illness are at greater risk for developing problems than children whose parents do not.

• Many children whose parents have mental illness do well.

(Nicholson, 1999)

Challenges Specific To Parents Challenges Specific To Parents With Mental IllnessWith Mental Illness

• Medication

• Hospitalization

• Relationships with helpers

• Advocacy

• Child’s perception of parent’s illness

• Child’s role in illness management

• Communicating with child about mental illness

(Nicholson, 1999)

Parental Mental Illness Risk Parental Mental Illness Risk FactorsFactors

• Decreased responsiveness/withdrawn from the child

• Limited ability to nurture

• Less positive and more negative behavioral interactions

• The more severe and chronic the mental illness the greater the risk

Risk Factors ContinuedRisk Factors Continued

• Inappropriate responsibilities placed on the child

• Multiple separations from the child

• Poverty

• Lack of social supports

Critical Components to Program Critical Components to Program Success Success

• Individual Consultation

• Parenting Education• Advocacy and

Support • Linkage and Referral• Planning for Crisis

Events• Workshops

• Cross Systems Collaboration

• Play and Recreation• Assistance with

Household Management

• Parent Mentor• Case Management

Key Components to Service Key Components to Service DeliveryDelivery

• Flexible Hours• Outreach Based

Services• Bilingual Staff• Strong Collaboration• Services Free of

Charge• Individualized

Planning

• Advocacy• Utilize Parent

Advocates• Mental Health

Education• Full Involvement of

Parent • Entire Family Involved• Hands on

Demonstration

EthnicityEthnicity

• White 19• African American 20• Hispanic 39• Other 2

(n = 80)

Age of ParticipantsAge of Participants

• 21 to 30 18

• 31 to 40 31

• 41 to 50 23

• 51 or older 8

(n = 80)

Marital Status of ParticipantsMarital Status of Participants

• Single, never married 37• Married 20• Divorced 14• Separated 8• Widowed 1

(n = 80)

Number of ChildrenNumber of Children

• One child 33

• Two children 21

• Three children 19

• Four children 5

• Five children 3

(n=167)

Income of ParticipantsIncome of Participants

• Receiving AFDC/Cash Assistance 50• Working, Income Below $17,050 18• Working, Income Below $25,575 0• Working, Income Below $34,100 0• Working, Income Above $34,100 6• Financial Support from Family 6

(n = 80)

Organizational StructureOrganizational Structure

• Board of Directors• Executive Director• Associate Executive Director• Director Of Consumer Parent Support Network• Assistant Director of Outreach Services• Support Specialist• Parent Advocates• Administrative Assistant• Volunteers• Interns

Parent Challenges Prior to Parent Challenges Prior to Involvement with CPSNInvolvement with CPSN

• 57 out of 80 parents were not receiving consistent mental health treatment

• 80 out of 80 parents had many concerns regarding interactions with their children

• 73 out of 80 parents were in significant financial distress

• 61 out of 80 parents are raising their children without support from other parent

Parent Challenges Parent Challenges

• 34 out of 80 parents speak Spanish only or minimal English

• 36 out of 80 parents did not graduate from high school

• 68 out of 80 parents had not effectively interacted with their child’s school

• 45 out of 80 parents are facing critical housing problems

Parent ChallengesParent Challenges

• All of the parents had reported significant social isolation for themselves and their children

• The majority of parents have had some form of legal issue (e.g., debt, evictions, child support, custody, domestic violence)

• All the parents reported significant difficulties with structuring their time and household routines

• Many parents had not been following up with or aware of their children’s medical, behavioral, developmental or learning disabilities

OutcomesOutcomes

• Parents will improve general parenting skills

• Parents will attend to their children’s basic needs

• Parents will learn how their mental illness affects their children

• Parents will create a plan for their children’s care in the event their symptoms significantly interfere with their ability to parent

• Parents will identify and create a system for social and family support

Contact InformationContact Information

Mental Health Association in Passaic CountyConsumer Parent Support Network

404 Clifton Ave.Clifton, NJ 07011

Rebekah Leon BA, CSWAssociate Executive Director

973-478-4444

Parenting with a Mental Parenting with a Mental IllnessIllness

TeleconferenceTeleconference

Presenter

Edie Mannion, M.F.T.

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

How Case Managers Can Help How Case Managers Can Help Behavioral Health Consumers with Behavioral Health Consumers with

Parenting & Child Custody IssuesParenting & Child Custody Issues

How Case Managers Can Help How Case Managers Can Help Behavioral Health Consumers with Behavioral Health Consumers with

Parenting & Child Custody IssuesParenting & Child Custody IssuesEdie Mannion, Mental Health Association of SE PAEdie Mannion, Mental Health Association of SE PA

Barbara Granger, The Matrix Center at Horizon HouseBarbara Granger, The Matrix Center at Horizon House

UPENN Collaborative on Community IntegrationUPENN Collaborative on Community Integration

…What Should BH Providers Do about…• The responsibility to

protect children and the mandate to report child abuse

• The responsibility to support clients and develop an alliance

CASE SCENARIO: A case manager is trying to help a client who is struggling to parent her sons, ages 5 and 3. She tells the case manager that her kids sometimes seem “possessed” because they throw themselves on the floor and use curse words. When visiting her apartment, the apartment seems dirty and disorganized, and the mother admits she has not cleaned it for the last few months because she is too “stressed out” from watching her “bad kids” all the time. The children seem to be of average weight for their ages and do not appear to have any signs of physical abuse, although their hygiene seems poor. They get their mom’s attention when they yell, throw things or bother each other. She claims she’s never had any involvement or services from the child protective service system, and angrily tells the case manager, “I don’t want nothing to do with them!”

1. Show Sensitivity to Parenting Issues

• Ask your consumers about their children!

• If they share parenting concerns or feelings about parenting or child loss, balance empathy with hope for having their parenting needs addressed

• Validate how many parents with illness or disability worry about parenting or fear losing child custody

• Reassure parents that if they want help with parenting concerns, you can link them to resources.

2.Will they commit to work on parenting

issues?“ “ DO YOU WANT DO YOU WANT

TO WORK TO WORK TOGETHER ON TOGETHER ON YOUR YOUR PARENTING PARENTING CONCERNS?”CONCERNS?”

3. Assess Their Custody

Arrangements• Use “Child Custody Assessment

Form” to explore child custody arrangements, identify key contact information and identify any concerns related to their children

• Offer to link them to resources that address their parenting needs

4. Identify Their Parenting Needs

A. Are sexually active, but no children yetDo they want to discuss birth control and readiness to parent?

B. Have children with no custody loss (yet):Do they want help avoiding the risk of being reported or losing child custody?

C. Are being investigated for child abuse:Do they want to know the do’s and don’ts?

D. Have lost legal custody of a child:Do they want help with reunification?

E. Have lost parental rights:Do they want counseling or support?

Helping Parents Avoid Being Investigated

Help parents understand state child abuse laws

so they can plan ways to avoid unintended neglect or abuse of their children…

Helping Parents Avoid Being Investigated (2)

● Help with organizing routines regarding school, health, dental, and play/social activities

● Linking them to resources that can help them understand & meet their children’s

developmental needs

● Identifying respite childcare before needed ● Expressing concerns & problem solving if you

observe warning signs of child abuse/neglect

Helping Parents Under Investigation

• Link to legal advice to learn their rights

• Discourage them from signing forms such as voluntary placement agreements or consents before consulting an attorney

• Encourage them to allow DHS into their home

• Remind them that anything they say or do can be used against them

• Identify any trusted family members or friends willing to take custody

Helping with Family Reunification

• Encourage clients to let you help them negotiate the child protective service system

• Remember that any information you provide to DHS can be held against your consumer

• Perhaps limit info to diagnosis, treatment recommendations, and compliance with treatment

Helping with Family Reunification (2)

• Provide information about your state’s laws and procedures for family reunification

• Ask to see their Family Service Plan (FSP)

• New federal laws mean that parents only have 12 months to achieve family service plan goals or risk losing their parental rights (adoption)!

• Provide tips and resources for meeting their FSP goals FAST…

Tips for Clients about Family Reunification

• Meet Family Service Plan (FSP) goals fast, including any goals specifying treatment

• Sign release forms that only allow treatment providers to release diagnosis, treatment recommendations and compliance with treatment

• Help your child understand your illness and that you are getting help

Tips for Consumers about Family Reunification (2)

• Establish a good relationship with everyone involved (Anger Management!)

• Educate your attorney about your illness

• Maintain as much contact with your child as possible and keep up with visits

• Keep notes of dates and events related to your case

• Be prepared for all FSP meetings & court hearings

Helping Parents Who Lose/Lost Parental Rights

• Adoption can be one of the most traumatic human experiences for parents & children, especially if the adoptive parent does not agree to open adoption

• Many parents will seek to have more children to replace the lost child, especially if their trauma and grief are not addressed…SO PROVIDE RESOURCES & SUPPORT

FOR GRIEF/TRAUMA COUNSELING!

You can help keep You can help keep families together!families together!You can help keep You can help keep families together!families together!

THANK YOU!THANK YOU!

Coming soon…

The UPenn Collaborative will be publishing a Guidebook to help parents with psychiatric disabilities in maintaining and regaining custody of their minor children.

Parenting with a Mental IllnessParenting with a Mental Illness

Teleconference ResourcesTeleconference Resources

Custody Assessment Worksheet: http://www.upennrrtc.org/resources/view.php?tool_id=38

Understanding Child Abuse & Neglect in Pennsylvania: A General Guide that Can Be Adapted for Parents in Other States: http://www.upennrrtc.org/resources/view.php?tool_id=118

Child Welfare and Custody Issues: http://www.upennrrtc.org/resources/view.php?tool_id=36

Positive Parenting and Child Resilience: http://www.upennrrtc.org/resources/view.php?tool_id=37

Parenting Guidebook: This guidebook was developed as a comprehensive resource to help parents, providers, and advocates find information about possible programs in their area. It will be updated as new information and programs come to our attention. http://www.upennrrtc.org/resources/view.php?tool_id=128

UPENN COLLABORATIVE ON

COMMUNITY

INTEGRATION

MAY 9, 2007