Supporting children who live with parental mental illness
Family SMILES was developed by the NSPCC to address identified gaps in service provision and to support children living with parental mental illness.
The NSPCC has a continual focus on developing, delivering and testing innovative services and solutions that aim to support children and young people. We have recognised that to reach more children with services that work, we need to work in partnership with other agencies to put evidence into practice. We follow a rigorous process to grow our services, which we are calling ‘scale up’. Part of this involves piloting services in our own service centres and with external partners, and evaluating how this works. My role as Development and Impact Manager is to help drive this part of the new service development process forward.
One of the five goals that support our strategy is to prevent abuse in families facing adversity, which includes families where parents may have mental health problems. This is because we know that when families face multiple adversities, such as mental health problems, substance misuse and domestic abuse, it can be harder for parents to deal with family life and can put pressure on relationships.
Between 2011 and 2015 we delivered Family SMILES, a service that aims to support children who live with parental mental illness, at 15 of our own service centres. During that time, a total of 191 parents and 333 children completed the programme.
Family SMILES (Simplifying Mental Illness plus Life Enhancement Skills) is based on the Australian SMILES programme, developed in 1997 by Erica Pitman. Over eight group sessions, children are helped to understand mental illness and how to develop life skills that will improve their ability to cope with their parent’s mental illness. Parents also receive one-to-one support to understand their child’s experience of living in a family with mental illness.
We developed Family SMILES because we had identified a gap in service provision for children living with parental mental illness. We wanted to make sure that it worked.
What we learnt from evaluating the service
To understand this better we undertook an evaluation to find out what impact the programme had on the children and families we were working with. We asked children, parents and practitioners what improvements they had seen because of the programme, what they found particularly helpful and what challenges they experienced.
The evaluation indicated that Family SMILES showed promise as an effective intervention but it became clear that the evaluation had limitations because the comparison group we were using was very small. This was because it had been formed from a naturally occurring waiting list for the programme.
Whilst we were delivering and evaluating Family SMILES, the University of Manchester were undertaking a systematic review of community-based interventions for families where parents have mental health difficulties. Family SMILES was the only programme they found that had promising findings for this particular age group. When the National Institute for Health Research (NIHR) put out a tender to fund the development of a new programme to address the gap in evidence based services, Manchester University saw the NSPCC as a natural choice for a delivery partner. Following a successful bid, we worked with the university to develop a programme that drew on learning from Family SMILES, but took a slightly different form. We called this new service, Young SMILES.
The learning from Family SMILES had suggested that this type of programme could be impactful and helped to justify the investment by the NIHR to generate a higher standard of evidence for this type of intervention. This has meant that together with the University of Manchester, we can do more to learn what works for these children and families.
What does Young SMILES look like?
The final design of Young SMILES is driven by the aims of improving the child’s understanding of mental illness, and their communication and problem-solving skills. Like Family SMILES, it is an eight week group work programme for children and young people, but we’ve extended the age range for children who have a parent with a serious mental illness from 6 to 16 years.
The group activities are based on those used in Family SMILES, but with the addition of a ‘made-up family’ that is used to help get across some of the session objectives. The made-up family is created with cardboard cut-outs and the family’s composition, circumstances and experiences are decided by the group. By using a made-up family that has similarities to the group members’ circumstances, children can begin to build a narrative that draws on their own experiences, which can help them to talk about their own situation. Parents and carers are also invited to four weekly group sessions that run in parallel to the children’s sessions and aim to help parents communicate with their children.
The future of Young SMILES
Young SMILES will be evaluated using a feasibility randomised controlled trial (RCT), which is a robust methodology. An RCT is where people are randomly allocated to receive the intervention being tested (in this case Young SMILES) or standard care (this means they receive treatment for their mental health problem but no extra parenting support). The randomisation element minimises selection bias and the comparison groups allow the researchers to determine any effects of the intervention when compared with the group that’s not receiving the intervention. All other variables are kept constant.
The NSPCC is now ready to start delivering and testing Young SMILES in Warrington and Coventry. Northumbria Trust is also testing Young SMILES in Newcastle. These sites are part of the feasibility RCT. If the feasibility is successful the University of Manchester will seek funding to expand the trial across more delivery sites.
By undertaking such a rigorous evaluation of this service, we can get a better understanding of how to support children living with parents who have a mental illness. By evaluating the service in partnership with external partners such as Northumbria Trust, we can also learn more about what works for others implementing new services.
About the author
Diane Hunter is a qualified social worker with over twenty years experience working within a range of children and families settings and at a strategic level. She now works for the NSPCC as Development and Impact Manager, helping to design, develop and test new services that aim to improve outcomes for children and afford greater understanding about what works best to achieve those outcomes.