UPENN COLLABORATIVE ON COMMUNITY
INTEGRATION OF INDIVIDUALS WITH DISABILITIES
presents
Parenting with a Mental Illness
An Innovative Teleconference
Co-sponsored by Mental Health America
May 9, 2007
UPENN COLLABORATIVE ON
COMMUNITY INTEGRATION
After the Teleconference,
please visit our web site at
www.upennrrtc.org
Parenting with a Mental Illness
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 presentations 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 Illness
Teleconference
Presenter
Joanne Nicholson, Ph.D.
UPENN COLLABORATIVE ON
COMMUNITY INTEGRATION
Creating Options for Families
Joanne Nicholson, Ph.D.
Center for Mental Health Services Research
University of Massachusetts Medical School
Worcester, Massachusetts, USA
Joanne.Nicholson@Umassmed.edu
508-856-8712
www.parentingwell.org
May 9, 2007
Toni Wolf, Executive Director
82 Brigham Street
Marlborough, Massachusetts
01752 USA
508-485-5051
twolf@employmentoptions.org
Who We Are at UMMS:
Multidisciplinary group:
psychology, occupational
therapy, public policy, mental
health law, rehabilitation
Researchers, clinicians,
advocates, family members
Parents with mental illness
Strategic Planning Group
EO, Inc. Mission Statement:
Through inspiration, support
& encouragement,
Employment Options creates a
home-away-from-home,
where people can overcome
barriers to employment and
discover personal growth, selfsufficiency, and hope.
Our Partnership
1995 –UMMS focus group at EO
Members started talking
Toni started listening
Family Project began
1996 – DMH supported housing
contract for services for 7
families
First Steps
Identified parents in club
Began to identify needs
Christmas presents
Suggestions for visits
Held holiday party
The (original) Family Project
DMH supported housing
contract
Parent is “identified client”
Need for DMH eligibility
Difficult to obtain
Requires major functional
impairment(s)
Our Partnership (cont’d.)
1997 – NIDRR-funded Parenting
Options Project
Regional Clubhouse Parenting
Consortium
ParentLink Newsletter
Parent Work Groups
“Parenting Well When You’re
Depressed”
Family Project Developments
Supervised
visitation
Home visits
Collateral
contacts
Crisis on-call
Social
activities
Advocacy for
children
Lessons Learned
Focus on entire families
“Warm line” vs. crisis on-call
Aggressive care management
Respite services
Flexible funds
Knowledge of adult, child & family
systems
“Messy” legal issues
Long-term involvement optimal
Our Partnership (cont’d.)
1999 – Clubhouse Family Legal
Support Project (CFLSP)
NAPIL funding
2002 – DMH funding
2003 – Massachusetts Bar
Foundation funding
Clubhouse Family
Legal Support Project
Consultation to adults re:
custody & family situations
Direct representation
Attorney at Mental Health Legal
Advisors Committee in Boston
Attorney, parents & clubhouse
advocate work together
Our Partnership (cont’d.)
2002 – SAMHSA-funded
“Strengthening Families”
Community Action Grant
Develop consensus re:
families’ needs
Consider feasibility of models
like Invisible Children’s
Project (ICP)
Activities of SAMHSA-funded
Strengthening Families Project
Stakeholders recruited
Champions created
Data re: needs collected
Community resources identified
Relevant model (ICP) examined
Agreement to adapt & implement
family model achieved
Outcomes of SAMHSA-funded
Strengthening Families Project
Concept paper
Advocacy plan
Exploration of funding
alternatives
Development of key
stakeholder relationships
Proposed model
Strategic Relationships Formed
MA Dept. of Social
Services
MA Dept. of
Mental Health –
children’s services
MBHP – Medicaid
MCO
Family Network
(early childhood)
CMHCs
Clinics
Homeless Services
Boys & Girls’ Clubs
Early Intervention
Local hospitals
Parents
Family Options
“Building resources and
relationships to promote
resilience and recovery in
parents with mental
illness and their children”
Intervention Innovation
Involves 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 & parenting
Builds on what we have learned
works best in a clubhouse setting
Requires shifting agency focus
Theoretical Foundation
Psych 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 Concepts
Family-centered
Strengths-based
Family-driven & selfdetermined
Recovery & resilience
Family Options Key Processes
Engagement &
relationship building
Empowerment
Availability & access
Liaison & advocacy
Family Options Team
Supervisor & 3 Family Coaches
Clinical Consultant
Provide:
Intensive outreach
Strengths assessment & goal
setting
24-hour availability
Flexible funds
Liaison & advocacy
Family Options Outcomes
Parent & Child
Well-being
Functioning
Supports & Resources
Family
Empowerment
Supports & Resources
Implementation Study
Study process of implementing
Family Options
Examine impact of required
paradigm shift within agency
from focus on individual
adults to families
Challenges to Implementation
– Program Level
Staffing, hiring, and training
Actualizing innovative concepts
Working with complex families
Allocating scarce resources
Challenges to Implementation
– Agency Level
“Integration” of new
program in existing agency
Sustainability
“We didn’t anticipate…..”
Challenges to Implementation
– Community Level
Nurturing and educating
community partners
Identifying suitable community
resources
Respite
Housing
“I think my children had difficult
experiences being raised by a
mother with mental illness. I’m
not going to pretend that it’s all
been easy. But there isn’t
anything that we experience that
doesn’t come with some blessing.
And I think there has been
blessing, even in the hard stuff.”
-Mother of two, living with mental illness
Parenting with a Mental Illness
Teleconference
Presenter
Rebekah Leon, B.A., C.S.W.
UPENN COLLABORATIVE ON
COMMUNITY INTEGRATION
The Consumer Parent Support
Network; A Comprehensive New
Jersey Program
Presenter:
Rebekah Leon, BA, C.S.W.
How to Support Parents with a
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
Parent Support Network is to
support parents with a diagnosis of
mental illness in their parenting
efforts and to promote the healthy
functioning of the family unit.
Learning 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
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
With 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
Factors
• 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 Continued
• Inappropriate responsibilities placed
on the child
• Multiple separations from the child
• Poverty
• Lack of social supports
Critical Components to Program
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
Delivery
• 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
Ethnicity
• White
19
• African American20
• Hispanic
39
• Other
2
(n = 80)
Age of Participants
•
•
•
•
21 to 30
31 to 40
41 to 50
51 or older
(n = 80)
18
31
23
8
Marital Status of Participants
•
•
•
•
•
Single, never married
Married
Divorced
Separated
Widowed
(n = 80)
37
20
14
8
1
Number of Children
•
•
•
•
•
One child
Two children
Three children
Four children
Five children
(n=167)
33
21
19
5
3
Income of Participants
•
•
•
•
•
•
Receiving AFDC/Cash Assistance
Working, Income Below $17,050
Working, Income Below $25,575
Working, Income Below $34,100
Working, Income Above $34,100
Financial Support from Family
(n = 80)
50
18
0
0
6
6
Organizational 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
Involvement 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
• 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 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
Outcomes
• 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 Information
Mental Health Association in Passaic County
Consumer Parent Support Network
404 Clifton Ave.
Clifton, NJ 07011
Rebekah Leon BA, CSW
Associate Executive Director
973-478-4444
Parenting with a Mental Illness
Teleconference
Presenter
Edie Mannion, M.F.T.
UPENN COLLABORATIVE ON
COMMUNITY INTEGRATION
How Case Managers Can Help
Behavioral Health Consumers with
Parenting & Child Custody Issues
Edie Mannion, Mental Health Association of SE PA
Barbara Granger, The Matrix Center at Horizon House
UPENN 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
TO WORK
TOGETHER ON
YOUR
PARENTING
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.
B.
Are sexually active, but
no children yet
Do they want to discuss
birth control and
readiness to parent?
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
• Encourage them to allow
DHS into their home
• Discourage them from
signing forms such as
voluntary placement
agreements or
consents before
consulting an attorney
• 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
families together!
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 Illness
Teleconference 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