Notice the Children Project 2003-2005

1. Notice the Children Project 2003-2005 Project Workers: Veli-Matti Saarinen and Hilkka Räisänen

2. Notice the Children Project 2003-2005 • According to many studies, parental mental illness burdens the whole family and is a risk to children´s mental health • The child's risk is estimated at 30 – 70% • Ten years ago we become concerned about the children of mentally ill parents • what to do, who to consult or whose responsibility it is to deal with the situation? • In Child psychiatric care we noticed that sometimes the children's parents suffered from psychiatric disorders • We suggested further measures to 56% of the children who were assessed during the earlier “Unnoticed Children Project” 1992 - 2002. • The study showed us the importance of prevention while noticing the children's situation. Notice the Children project is focusing on that fact • If we want to notice the children systematically we need education and consultation to the adult psychiatric staff and collaboration between adult and child psychiatry Project Workers Veli-Matti Saarinen and Hilkka Räisänen

3. Notice the Children Project 2003 - 2005 Discussion with the ps. staff and the patient Reasons for concern: . parent´s concern for the children . family violece . intoxicant abuse . psychotic symptoms Own motivation Voluntary basis Should the children learn about the illness Psychiatric staff . outpatient clinics . wards Referral . chronic depression of the parent etc. • Training, consultation,work supervision • Beardslee family intervention 8 days • Mini-intervention training 1day • Feedback • meeting • Informal • support netw • and multiprof • team • Immediately • and 6 months • later Notice the children Project Negotiation - two project workers -parents and primary nurse • Beardslee’s family intervention • 6 –8 sessions • parents and children • Negotiations on further • examinations, care or • support to the child/family • Various therapies • FCC, OM, CPC • Child protection • Assessment of the • child and family • Interviews of • parents /children • YSR, CBCL, TRF • -tools • Home visits • Multiprofessional • negotiations Concern about the children’s psychiatric health or family’s welfare Concern about the other parent The other parent’s referral to care

4. Notice the Children Project 2003-2005 Methods: • Assesment of the child´s and family´s situation - CBCL,YSR,TRF (Achenbach/Almqvist) - home visits, interviews of parents and children - observation of the family system • Beardslee´s Family Intervention/Mini Intervention - supporting parenthood, promoting protective factors in the child’s life, supporting family interaction - psychoeducation • Providing examinations, care and support services - multiprofessional collaboration, follow-up negotiations • Training, consultation, work supervision • Training and work supervision for project workers • Collaboration between project workers, child and adult psychiatric units Projectworkers: Hilkka Räisänen and Veli-Matti Saarinen

5. Notice the Children Project 2003 -2005 • Results: - The participants (1.9.2003 - 11.4.2005) were 48 families including 119 home-living children aged 0-21 - Further measures Child/adolescent psychiatric clinic 8% Family counselling clinic 33% Child social welfare clinic 41% Other measures: primary health care, follow up etc 13% • In 11 out of 48 families, the other parent was referred to care - 2 adult children were referred to psychiatric care Projectworkers: Hilkka Räisänen and Veli-Matti Saarinen

6. Notice the Children Project 2003 -2005 • Conclusions: • Both the families and the collaborating partners have experienced the project positively • To ensure that the children of psychiatric patient are noticed, we need intensified multiprofessional collaboration, further training, a supervision and consultation system and a set of quality criteria and instructions to notice the children • In clinical work, the families’ multiple problems and great child protection needs have been surprising • Work with informal support networks and multiprofessional work have increased from the time of the earlier project, and a further increase is indicated • Families appreciate the long term support; plans are made for follow-up negotiations even one year after ending the intervention • The project revealed the lack of recourses in primary psychiatric and social services. Resources in primary services should be an essential part of prevention Project Workers Veli-Matti Saarinen and Hilkka Räisänen