Steps Toward Evidence-Based Practices for Parents
with Mental Illness and their Families

Discussion

The rationale for achieving the goal of evidence-based practices for parents with mental illness and their families has been documented in previous work (Nicholson, Biebel, Hinden, Henry, & Stier, 2001). The next steps, of describing and documenting existing programs, were undertaken in the studies described in this paper. Core program components and key ingredients have been identified across programs through extensive interviewing and site visits. Program goals suggest relevant outcomes.

Core Program Components. Comprehensive family case management or care coordination is a common component across programs. Case managers are supported in providing and coordinating services for families as a collective unit, as well as for individual family members. Access to a comprehensive array of services, from housing to vocational training to early childhood education, to meet family and individual needs is essential, either within an agency context or in the larger community. Coordination of multiple services and the facilitation of communication among multiple providers are important to families. The ability to provide concrete assistance such as rent is essential, highlighting the value of flexible funds to meet unique family and individual needs. Crisis intervention services, available 24 hours a day, seven days a week, were identified as important. Programs also shared a focus on providing education regarding child development, enhancing parent-child relationships, and developing parenting skills.

Key Ingredients. The data presented here indicate that family-centered, strengths-based values and practices may be the central key ingredients to program success and improved outcomes for parents and children. Regardless of target population or theoretical orientation, programs uniformly embraced family-centered, strengths-based approaches to working with parents with mental illness; and providers and participants unequivocally said these values and practices were critical to success. In the process of developing program logic models, it became apparent that providers believe these key ingredients directly and indirectly influence outcomes, through enhancing parental self-esteem and confidence, and fostering positive relationships between providers and consumers.

Family-centered approaches posit the family as the unit of service, and optimal family functioning as the desired outcome. A family-centered approach is best served through the integration of adult and child services and systems, interagency collaboration, and the availability of non-categorical, flexible funding in the service of the entire family. Equally important to service coordination, the development of a trusting, emotionally supportive relationship between provider and consumer appears to be critical. Strengths-based, non-judgmental approaches, and unconditional care appear to be the foundations for this relationship.

Relevant Outcomes. Rigorous program evaluation demands that outcomes are meaningful and important to participants, fit conceptually with programs' theories of change and intervention targets, and are able to measured in objective, standardized ways. Programs for parents with mental illness and their children share a focus on optimal functioning of parent and child, indicating that assessment of adult and child functioning in significant role domains, as well as reduction in distress or symptoms, and increased number of planned rather than crisis hospitalizations or respite placements could be common outcomes. Program goals of enhancing the parent-child relationship and preserving the family unit suggest important outcomes of increased frequency of positive parent-child interactions, decreased out of home placement, or successful family reunification. The achievement of basic family needs is essential, and reflected in outcomes like securing stable housing or employment, and achieving access to health care or childcare. Enhanced social networks and family supports would be relevant outcomes in most programs. Capturing improvements in parenting skills represent perhaps the most difficult methodological challenge. Child-related outcomes, other than those in functioning or distress sited above, could include developmental milestones achieved, school readiness, and improved school attendance.

Next Steps

The next steps toward evidence-based practices for parents with mental illness and their families involve mustering the resources and providing necessary technical assistance to support providers in standardizing and manualizing their interventions. Research methods and tools must be identified or developed that adequately reflect participant and program goals and theories of change, capture program process and fidelity, and objectively measure important, meaningful outcomes related to adult, child, and parent functioning and the parent-child relationship. Once these steps have been taken, rigorous evaluation across programs and target populations can begin. Standardized, objective evaluation will not happen, however, without an influx of resources-stable program funding and increased research and evaluation support; new and improved research methods and tools; and researchers knowledgeable of both intervention and evaluation challenges when families living with mental illness are the focus.

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Steps Toward Evidence-Based Practices for Parents with Mental Illness and their Families

Discussion

Steps Toward Evidence-Based Practices for Parents
with Mental Illness and their Families