‘Keeping families and children in mind’: an evaluation of a web-based workforce resourcecfs_731 192..200
Andrea Reupert*, Kim Foster†, Darryl Maybery‡, Kylie Eddy§ and Elizabeth Fudge¶ *Senior Lecturer, Department of Rural and Indigenous Health, Monash University, Moe, Victoria, †Associate Professor,
Mental Health Nursing, University of Sydney, Camperdown, NSW, ‡Associate Professor of Rural Mental Health,
Department of Rural and Indigenous Health, Monash University & Gippsland Medical School, Moe, Victoria, and
§Workforce Development Officer, ¶Project Manager, Children Of Parents with a Mental Illness (COPMI) national
initiative, North Adelaide, South Australia, Australia
This study outlines pilot evaluation data of the web-based training resource ‘Keeping Families and Children in Mind’, designed for clini- cians who work with families where a parent has a mental illness. The resource was developed from scoping existing workforce packages and in consultation with consumers, carers, researchers and mental- health clinicians. Preliminary evaluation data were collected from an urban and a rural site in Australia via focus group interviews and pre- and post-training questionnaires to ascertain the experiences of those who participated in the training. Additionally, training facilitators were invited to maintain journals in order to identify planning and implementation issues when using the resource. Post-training, partici- pants emphasized the need to work collaboratively with others, as well as the importance of acknowledging and working with the family members of consumers, especially children. Also, participants reported positive changes in knowledge, skill and confidence when working with families affected by parental mental illness. Facilitators highlighted technology issues and the need to work interactively with participants when using the resource. Recommendations regarding policy and future research conclude this paper.
Correspondence: Andrea Reupert, Department of Rural and Indigenous Health, Monash University, PO BOX 973, Moe, Victoria, Australia E-mail: email@example.com
Keywords: children, evaluation, families, parental mental illness, web-based workforce training
Accepted for publication: August 2010
Mental illness is a family affair, particularly where a parent, with dependent children, has a mental illness. Several studies indicate that children where a parent has a mental illness may be at twice the risk of devel- oping a mental illness diagnosis compared to other children (Black et al. 2003; Park et al. 2003; Cunning- ham et al. 2004; Leschied et al. 2005; Edwards et al. 2006). Other studies highlight the range of behav- ioural, interpersonal, academic and other difficulties that children of parents with a mental illness might face (Rutter & Quinton 1984; Farahati et al. 2003; Maughan et al. 2007; Reupert & Maybery 2007). An
epidemiological study has estimated that between 21 and 23% of all families have, or have had, at least one parent with a mental illness (Maybery et al. 2009). Thus, given the prevalence of families affected by parental mental illness and the potential difficulties they face, it is important that the mental-health work- force is appropriately skilled at identifying and subse- quently intervening with children and their parents. This paper describes a web-based training resource, ‘Keeping Families and Children in Mind’ designed for the mental-health workforce, and the results of a pilot evaluation of the resource.
While there is ample evidence highlighting the need for early intervention, children living in families where
192 Child and Family Social Work 2011, 16, pp 192–200 © 2010 Blackwell Publishing Ltd
a parent has a mental illness have been described as ‘hidden’, because clinicians are often unaware that consumers are parents with dependent children (Fudge & Mason 2004). In the USA, it is suggested that agencies take a categorical approach and focus on either the child (e.g. in terms of child protection) or the adult (e.g. for his or her mental-health needs) (Nicholson et al. 2001). Maybery & Reupert (2006) found that while many Australian adult mental-health clinicians want to work with all family members, they report clear skill and knowledge limitations, a finding also confirmed in a Finnish study with psychiatric nurses (Korhonen et al. 2008). Slack &Webber (2008) found that even though many adult mental-health workers favour supporting children of consumers, they did not necessarily consider it their role to do so. Maybery & Reupert (2009) summarize workforce barriers in terms of (i) policy and management; (ii) inter-agency collaboration; and (iii) clinician attitude, skill and knowledge.
Notwithstanding these barriers, acknowledging and working with family members has been shown to be beneficial to the consumer, his or her children and other family members (Glynn et al. 2006; Beardslee et al. 2008). For example, it has been found that a family-focused intervention was effective in reducing the exacerbations in schizophrenia, improving medi- cation compliance and reducing or eliminating sub- stance abuse (Glynn et al. 2006). Family-sensitive practice is beneficial to the consumer as well as other family members, by reducing a family’s subjective burden of care and increasing their level of self-care and emotional functioning (Glynn et al. 2006). Fur- thermore, acknowledging and working with children
of parent consumers improves family functioning and children’s understanding of their parent’s disorder as well as a reduction in children’s internalizing symp- toms (Beardslee et al. 2008). Given the efficacy of a family-sensitive approach, it is imperative that training is designed and developed in ways that addresses the current skill and knowledge gaps found in the workforce.
In response to the training needs of the mental- health workforce, a resource ‘Keeping Families and Children in Mind’ was developed by the Australian National COPMI (Children of Parents with a Mental Illness) initiative through scoping existing workforce packages and then identifying main themes and issues across these packages (Reupert et al. 2009). Addition- ally, the resource was developed using a Delphi process (see Note 1) with 14 experts consisting of consumers, carers, researchers and mental-health clinicians (Whitman et al. 2009). These experts responded to questions about curriculum content and teaching processes in three Delphi ‘rounds’ until con- sensus was reached. In this process, experts were asked to summarize themes (generated from previous Delphi rounds) that resulted in the final six core modules of the resource (see Table 1).
The resulting Keeping Families and Children in Mind: COPMI Mental HealthWorker Education Resource deliv- ers an interactive, audio and video material using Web 2 technology. Clinicians might focus only on those modules that are of interest and/or need or undertake all six modules. The resource includes a variety of educative web pages and links, and video and audio inserts of families describing what it is like to live with parental mental illness as well as clinicians reporting
Table 1 The six modules of ‘Keeping Families and Children in Mind: COPMI Mental Health Worker Education Resource’
1 Mental Health and Families – introduces a family where a parent experiences mental illness. Information is also provided by parents, children and workers about factors that contribute to mental health and illness, stigma and mental illness and family support.
2 The Parent – introduces a second family. Information is provided about the impact of mental illness on parenting, the impact of parenting on mental illness and the recovery process.
3 The Child – provides an opportunity to reflect on the experiences of children in two families where a parent experiences mental illness. Information is provided on risk and protective factors that influence child well-being, including the impact of parental mental illness on child development. There are demonstrations of how talking to children can assist in their understanding of what is happening at home.
4 The Family – highlights the importance and influence of the family unit in the recovery of a parent who experiences mental illness, including influences on family functioning, family resilience and working with families using a strengths-based approach.
5 Carers – presents the perspective of family carers with a particular emphasis on the issues faced by young carers and grandparents who provide care for children of parents who experience mental illness.
6 Putting it into Practice – provides opportunities for learners to reflect on their work practice at an individual and systems level in regards to supporting families where a parent experiences mental illness. It provides practical examples of what workers are currently doing across Australia and an extensive list of accessible resources.
‘Keeping families and children in mind’ A Reupert et al.
193 Child and Family Social Work 2011, 16, pp 192–200 © 2010 Blackwell Publishing Ltd
about their experiences working with such families. The resource also provides scenarios about fictitious families that encourage mental-health clinicians to reflect on their clinical practice. Clinicians are able to access the resource in a web-based, self-paced mode, or alternatively, attend facilitator-led training using the resource in a group format. The resource is freely accessible at http://www.copmi.net.au/worked/ index.html
At the point of writing, several Australian state mental-health services have indicated that they will incorporate this resource as part of a large ‘roll out’ of training, with similar indications from overseas researchers and trainers (personal correspondence to the authors). Consequently, as there are likely to be hundreds and perhaps thousands of clinicians who will use this resource, it is essential to report initial data about the utility of the resource. Currently, a further evaluation of the large-scale roll out is planned, although it will take some time to collect and analyse a larger data set.Thus, this paper summarizes preliminary efficacy data from the piloting of the training resource.