14/7/131 SMILES PROGRAM INTRODUCTION & LONGITUDINAL FOLLOW UP Simplifying Mental Illness + Life Enhancement Skills Created by Erica Pitman

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SMILES PROGRAM

INTRODUCTION & LONGITUDINAL

FOLLOW UPSimplifying Mental Illness + Life Enhancement

Skills

Created by Erica Pitman

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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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PIE CHART - Feelings

SAD

ANGRY

EMBARRASSED

PROGRAM ACTIVITY

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EVALUATION

0

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2

3

4

5

6

7

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

10

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

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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.”

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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

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• 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.


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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


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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


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• 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.


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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

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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


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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”


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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


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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

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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)


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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).


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SMILES PROGRAMFREE down-load

AICAFMHA COPMI Website: www.copmi.net.au/smiles

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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

Documents

14/7/131 SMILES PROGRAM INTRODUCTION & LONGITUDINAL FOLLOW UP Simplifying Mental Illness + Life Enhancement Skills Created by Erica Pitman