Family-to-Family Support
Serene Olin
Columbia University/New York State
Psychiatric Institute
Columbia Parent Empowerment Team:
Kimberly Hoagwood, Geraldine Burton, Marlene Penn,
James Rodriguez, Priscilla Shorter
Outline
 Family-to-Family
Support: Components
and Research Findings (Hoagwood et al., 2010, Clinical
Child and Family Psychology Review)
 Application
of Theories of Change to
Family-to-Family Support (Olin et al., 2009, Journal of
Child and Family Studies)
 Implications
for research and evaluation
Evolving model: Family Peer Advocates in
Children’s Mental Health

Peer parents address stigma, isolation, distrust, and
blame that many parents experience

RWJ/MacArthur Fdn Survey: Documents increase in #
of family organizations, parent membership nationally

F2F grassroots education programs available for free for
parents in NAMI, CHADD. 12,000 attended NAMI
Basics in first year roll-out

Workforce capacity shortages; new roles for family peer
advocates

Peer support billable for adults; billable for families of
children in some states
Goal of Review
1.To
provide conceptual consistency in the
definition of family support services
1.To
identify core components of FS services
1.To
examine various models of FS delivery, and
1.To
assess the status of the research on the
impact of family support services, and family to
family services in particular.
Family Support:
Research Review & Synthesis
(Hoagwood, Cavaleri, Olin, Burns, Slaton, Gruttadaro, Hughes, 2010)

Over 200 family support interventions/programs
with caregiver component were examined

50 met criteria for having



Structured or formal curriculum
Some evaluation data
Focus on caregiver needs or well-being
Definition of Family Support

(a)
Services or interventions directed parents or caregivers
of children with mental health needs with the explicit
purpose of helping caregivers
clarify their own needs or concerns;
(b) reduce their sense of isolation, stress, or self-blame;
(c) provide education or information;
(d) teach skills; and
(e) empower and activate them, so that they can more
effectively address the needs of their families.
Family Support Components

1.
Informational/Educational Support
Education about child behavior/development, course of mental
illness and its impact, treatment options, child and family service
systems and other resources.

2.
Instructional/Skills Development Support
A. Coaching caregiver on effective ways to address their child’s
illness or behaviors.
B. Skill-building directed at addressing caregiver’s personal wellbeing (e.g., communication, problem-solving, crisis management,
stress management skills)
Family Support Components

3.
Emotional and Affirmational Support
Shared communication among families and/or between providers
and families to promote caregiver’s feelings of being affirmed,
understood and appreciated.

4.
Instrumental Support
Concrete services such as respite care, transportation, and flexible
funds for emergencies.

5. Advocacy Support
A. Provision of specific information about parental rights and
resources (e.g., legislation, entitlements), coaching on ways to
effectively negotiate for services, or provision of direct advocacy to
obtain services for a caregiver or child.
B. Leadership skill building to develop caregiver as an advocate at
policy and service system levels.
Comparison of Family Support Programs by
Type of Support and Provider
Type of
Support
Family Led
(n=11)
Clinician Led
(n=33)
Team Led
(n=6)
Total
Programs
(N=50)
Information
Education
n=10 (91%)
n=22 (44%)
n=5 (83%)
37 (74%)
Instructional/
Skills
Development
n=10 (91%)
n=26 (79%)
n=5 (83%)
41 (86%)
Emotional
n=6 (55%)
n=10 (30%)
n=6 (100%)
22 (44%)
Instrumental
n=3 (27%)
n=0
n=3 (50%)
6 (12%)
Advocacy
n=11 (100%)
n=7 (21%)
n=5 (83%)
23 (46%)
Key Findings

Similar activities/functions across provider categories, but emphasis
differed

Clinicians focused on



Family providers emphasized




Skill building related to management of child symptoms
Parent needs, in service of increasing parent capacity to support child treatment
compliance
Building skills to increase parents’ personal coping skills, respite, and self-care
Cognitions or emotions about experiences with goal of problem-solving child
management issues;
Advocacy supports (more apt to recognize and discuss system level barriers
than parent level barriers to service access/participation)
Team Led providers were more comprehensive, with a more
balanced emphasis across the different types of support
What makes Family-to-Family Support Different?

Credibility and trust: peer parents provide a role model to
reduce isolation, sense of blame, and facilitate sense of
empowerment

Provides a linkage to community resources and services

Assists parents in identifying their own needs and concerns


Skill building focused on coping, self-care, crisis
management, problem solving skills and other personal skill
development
Emotional support in the form of facilitated sharing of
experiences and social connections to other parents
Impact of Family Support

Data on parent-to-parent services is limited; benefits
found most consistently related to caregiver satisfaction

Data from clinician-led models are most rigorous, and
generally indicate caregiver support produces superior
child outcomes compared to standard treatment

Benefits found for parent mental health, parent selfefficacy, stress levels, and perceived social supports and
skills; family functioning; treatment engagement and
reduced barriers to care
Training Family Peer Advocates:
The Parent Empowerment (PEP) Model
The Parent Empowerment (PEP) Model

Background: Developed in collaboration with family
advocates, researchers and policy-makers

Goal: Better prepare family advocates to more
effectively address the needs for families whose children
have MH difficulties

Training focus:





Engagement skills
Information/education
Emotional support
Advocacy support
Facilitate integration in workforce, with emphasis on roles,
boundaries, core competencies
14
The PEP Framework:
A Model for Working with Families
Principles
of
Family
Support
Parents as
Agents of
Change
Model
Goal: The overarching framework for PEP brings together what
we know from the parent support field and behavioral science,
and combines them into a model for working with parents.
15
Application of Behavioral Science Theories

Decades of research have produced hundreds of
studies on factors that influence actions and
behaviors

These studies rely on a small group of theories
whose core elements have been expanded into a
Unified Theory of Behavior (UTB) (Jaccard et al., 1999, 2002)

UTB is conceptualized along 2 dimensions:
a. Factors that motivate intentions (e.g., beliefs and
expectations, attitudes, social norms, self-concept, affect and
emotions)
b. Factors that determine actions (e.g., intentions, knowledge,
skills, environmental constraints, prior habits, priorities)
16
Adaptation of UTB Model
Expected Value
What do I get out of this?
INTERVENTION
STRATEGY
Social Norms
Should I do it? What will
important others think?
Attitudes/Affect
How do I feel about it?
Intention to
Act
Behavior/Acti
on
Self-Efficacy/Ability
Can I do it, and do it well?
Intervention Target
Possible Barriers
Skills/Knowledge,
Habits, Environmental
Obstacles, Priorities
17
PEP Conceptual Framework
Goals
Expected Value
Does parent feel that the
action will have direct
impact for child/family?
Parent Support …
Family Peer
Advocate
STRATEGIES
Social Norms
What does parent think
important others will think?
What do other parents do?
Attitudes/
Feelings/Beliefs
Intentions
Action
How does the parent feel
about MH, providers or
systems, or the action?
SelfEfficacy/Ability
Does parent see self as
competent or effective?
Intervention Target
Possible Barriers
Is Individualized
Facilitates Linkages
Is Respectful and
Culturally &
Linguistically
Competent
4. Builds Skill
5. Increases Knowledge
6. Is Engaging
7. Problem Solves
8. Focuses on
Outcomes and
Successes
9. Broadens Horizons
10. Promotes Advocacy
1.
2.
3.
Skills/Knowledge,
Habits, Environmental
Obstacles, Priorities
Framework:
Application of PEP
Parents as Change
Agents
Advocate Strategies: Provide
information, teach skills, share
experience, problem solve,
model behavior
What do I get
out of this?
What do
important
others think/do?
How do I feel
about mental
illness? (Attitudes,
Parent Goal:
Understand my
child’s behavior
Intention to
call MH
agency
Call MH
agency
beliefs, stigma, past
experiences)
Do I believe I
know how to
navigate the
system?
Intervention Target
Possible Barriers
Knowledge about disorder,
service systems, skills to
navigate system,
obstacles, competing
priorities
Summary of PEP Model
•
Support Active Listening Skills to Give Parents A
Voice and Get The Parents’ Story
•
Use “Principles of Parent Support” to Help
Parents Set Priorities
•
•
•
Determine and prioritize parents’ needs/concerns
Set realistic goals with parents
Use “Parents as Agents of Change” to
Make It Work
•
•
•
Determine action with parents
Identify potential strategies to support parents
(e.g., provide information, teach skills)
Anticipate obstacles and problem solve
20
Implications of Research Review and PEP
Model for Family-to-Family Services





Data on impact of family-to-family support is limited
Need to examine impact on outcomes for families
(beyond parent satisfaction)
Research synthesis delineates at least 5 identifiable
components of family support
PEP model provides a theory-driven approach to
systematically identify points of leverage to improve
impact of family support services
Research on impact of family-to-family support is critical
to lend greater legitimacy and sustainability of a critical
and rapidly developing service in children’s MH