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An Innovative Teleconference Co-sponsored by Mental Health America May 9, 2007. UP ENN C OLLABORATIVE ON C OMMUNITY I NTEGRATION. UP ENN C OLLABORATIVE ON C OMMUNITY I NTEGRATION OF I NDIVIDUALS WITH D ISABILITIES presents Parenting with a Mental Illness. After the Teleconference,

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an innovative teleconference co sponsored by mental health america may 9 2007
An Innovative Teleconference

Co-sponsored by Mental Health America

May 9, 2007




After the Teleconference,

please visit our web site at

Teleconference Presenters

Katy Kaplan, M.S.Ed.


Joanne Nicholson, Ph.D.

Rebekah Leon, BA, C.S.W.

Edie Mannion, M.F.T.



Parenting with a Mental Illness
Please Note:

The Teleconference Presenters have generously made their PowerPoint presenta-tions available on this web site. Any information used from these presentations must be cited, and proper credit given to the author.

Thank you!



parenting with a mental illness teleconference presenter joanne nicholson ph d
Parenting with a Mental Illness



Joanne Nicholson, Ph.D.



Creating Options for FamiliesJoanne Nicholson, Ph.D.Center for Mental Health Services ResearchUniversity of Massachusetts Medical SchoolWorcester, Massachusetts, [email protected]gMay 9, 2007
toni wolf executive director
Toni Wolf, Executive Director

82 Brigham Street

Marlborough, Massachusetts

01752 USA


[email protected]

who we are at umms
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, self-sufficiency, and hope.
our partnership
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
First Steps
  • Identified parents in club
  • Began to identify needs
    • Christmas presents
    • Suggestions for visits
  • Held holiday party
the original family project
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
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

Family Project Developments
lessons learned
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 d1
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
Clubhouse FamilyLegal 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 d2
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
Activities of SAMHSA-fundedStrengthening 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
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)



Homeless Services

Boys & Girls’ Clubs

Early Intervention Local hospitals


Strategic Relationships Formed
family options
Family Options

“Building resources and relationships to promote resilience and recovery in parents with mental illness and their children”

intervention innovation
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
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 (SearchInstitute)
family options key concepts
Family Options Key Concepts
  • Family-centered
  • Strengths-based
  • Family-driven & self-determined
  • Recovery & resilience
family options key processes
Family Options Key Processes
  • Engagement & relationship building
  • Empowerment
  • Availability & access
  • Liaison & advocacy
family options team
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
Family Options Outcomes
  • Parent & Child
    • Well-being
    • Functioning
    • Supports & Resources
  • Family
    • Empowerment
    • Supports & Resources
implementation study
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
Challenges to Implementation – Program Level
  • Staffing, hiring, and training
  • Actualizing innovative concepts
  • Working with complex families
  • Allocating scarce resources
challenges to implementation agency level
Challenges to Implementation – Agency Level
  • “Integration” of new program in existing agency
  • Sustainability
  • “We didn’t anticipate…..”
challenges to implementation community level
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
Parenting with a Mental Illness



Rebekah Leon,B.A., C.S.W.



The Consumer Parent Support Network; A Comprehensive New Jersey ProgramPresenter: Rebekah Leon, BA, C.S.W.
how to support parents with a mental illness
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
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
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
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
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
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


Cross Systems Collaboration

Play and Recreation

Assistance with Household Management

Parent Mentor

Case Management

Critical Components to Program Success
key components to service delivery
Flexible Hours

Outreach Based Services

Bilingual Staff

Strong Collaboration

Services Free of Charge

Individualized Planning


Utilize Parent Advocates

Mental Health Education

Full Involvement of Parent

Entire Family Involved

Hands on Demonstration

Key Components to Service Delivery
  • White 19
  • African American 20
  • Hispanic 39
  • Other 2

(n = 80)

age of participants
Age of Participants
  • 21 to 30 18
  • 31 to 40 31
  • 41 to 50 23
  • 51 or older 8

(n = 80)

marital status of participants
Marital Status of Participants
  • Single, never married 37
  • Married 20
  • Divorced 14
  • Separated 8
  • Widowed 1

(n = 80)

number of children
Number of Children
  • One child 33
  • Two children 21
  • Three children 19
  • Four children 5
  • Five children 3


income of participants
Income of Participants
  • Receiving AFDC/Cash Assistance 50
  • Working, Income Below $17,050 18
  • Working, Income Below $25,575 0
  • Working, Income Below $34,100 0
  • Working, Income Above $34,100 6
  • Financial Support from Family 6

(n = 80)

organizational structure
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
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
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 challenges1
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
  • 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
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


parenting with a mental illness teleconference presenter edie mannion m f t
Parenting with a Mental Illness



Edie Mannion,M.F.T.



how case managers can help behavioral health consumers with parenting child custody issues

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
…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.

1. Show Sensitivity to Parenting Issues
2 will they commit to work on parenting issues
2.Will they commit to work on parenting issues?


3 assess their custody arrangements
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. 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?

Have lost legal custody of a child:

Do they want help with reunification?

Have lost parental rights:

Do they want counseling or support?

4. Identify Their Parenting Needs
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
helping parents avoid being investigated 2
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

Discourage them from signing forms such as voluntary placement agreements or consents before consulting an attorney

Encourage them to allow DHS into their home

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 Parents Under Investigation
helping with family reunification
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
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
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
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
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…


coming soon
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:

Understanding Child Abuse & Neglect in Pennsylvania: A General Guide that Can Be Adapted for Parents in Other States:

Child Welfare and Custody Issues:

Positive Parenting and Child Resilience:

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.



MAY 9, 2007