EVALUATION OF DEVELOPMENT OF PSYCHIATRIC FAMILY

REHABILITATION FOR CHILDREN AND ADOLESCENTS-preliminary results

Tartu 31.10.2007

Pirjo Lehtoranta, Centre for Rehabilitation Research & Development, Rehabilitation Foundation, Helsinki, Finland

Ritva Linnakangas, Asko Suikkanen and Aila Järvikoski, University of Lapland, Rovaniemi, Finland

Content

• Background of psychiatric family rehabilitation in Finland

• Projects

• Our evaluation task

• Preliminary results

– implementation of projects

– children and adolescents in projects

– outcomes of family rehabilitation

• What is now going on

• Conclusions

Background of psychiatric family rehabilitation

• About 20% of school age Finnish children have some degree of psychiatric disorder. Most typical are attention deficit disorders and behaviour and oppositional defiant disorders. They can also appear at the same time. Other typical are: anxiety and phobic disorders.

• 15-25% of adolescents suffer from long term symptoms; attention and behaviour disorders, anxiety disorders, depression or substance abuse.

• To improve the situation the Finnish Social Insurance Institution funded 11 projects to support the child and the family and to develop new models for psychiatric family rehabilitation.

• The evaluation of the work of projects is carried out by the University of Lapland and Rehabilitation Foundation.

Project locations

Rovaniemi

Oulu

KajaaniKokkola

Kuopio

JyväskyläSeinäjoki

Tampere

KotkaHelsinki

TurkuYläne

Psychiatric family rehabilitation projects (11)

The main objectives for projects by Finnish Social Insurance Institution:

– Support for child/adolescent and family

– Co-operation between municipalities and hospital districts

– Multi-professional teamwork

– New models for psychiatric family rehabilitation

Evaluation TaskObjectives and Data

Objectives of evaluation of 11 family rehabilitation projects (2006-2009):

1. Description of the implementation models of the projects

2. Description of the target group (children and adolescents)

3. Outcomes of family rehabilitation at the individual and family level

4. Data on co-operation between projects and their networks

Data is gathered from the project workers, children / adolescents and their parents and the organisations within the co-operation network. Quantitative and qualitative data is used.

Implementation of projects

Outpatient models

• different groups for children and parents

• individual contacts mostly with children

Outpatient and inpatient models

• individual contact, and groups for children and parents, actions together

• weekends for adolescents, adolescent groups and some meetings with the whole family

Content: action oriented rehabilitation, therapies, peer groups, networks etc. Length: 1-2 years.

Children/adolescents (n 578) from the year 2006

Figure 1: Gender by age

Referrals of the children and adolescents to family rehabilitation

Referring organisation type n %

Child guidance and family counselling centre51 9

Specialized outpatient clinics 207 36Psychiatric clinic for children 108Neurological clinic for children 47Psychiatric clinic for adolescents 52

Health Centre 122 21

Private doctor 53 9

School 105 18

Others 40 7

Total 578 100

Mental problems of the children and adolescents, % (ICD 10)

5-11 yr 12-26 yr

Neuropsychiatric disorders 40 28

Anxiety disorders 15 21

Disorders of conduct and emotions21 18

Depressions 5 14

Socioeconomical and psychosocial problems

6 6

Learning difficulties 8 5

Others 5 7

Total 100 100

Total

19

26

16

20

7

3

9

100

Reasons to take part in family rehabilitation (1)

80% of families mentioned a reason concerning the child /adolescent e.g.

– behaviour problems

– difficulties in emotional life

– attention and hyperactivity

– peer problems

– difficulties in social skills and 

– low average grades at school

Reasons to take part in family rehabilitation (2)

20% of families mentioned a reason concerning the family e.g.  

– support in coping with parenthood

– need for information

– sharing experiences

– worry for the child

– wish to understand better the behaviour of the child

Changes in the children and adolescents reported by the

parentsFamilies

(n=66)

%

Changes in emotional lifeexpresses emotions, more cheerful, better mood and confidence

Change in peer relationshipmakes contact, has friends

Change in social activitiesmore courageous, active, less social fears, takes initiative

Change in attention and hyperactivitymore attentive, concentrates better, less hyperactive

Change in conductbetter self-control, not losing temper, no fights, obedient

Change at schoolbetter at school, eager to learn more

Any negative changeprone to friends' negative influence, more oppositional, dropped out of school

31 47

16 24

15 23

14 21

12 18

5 8

3 5

Helpful things for the children/ adolescents in rehabilitation according to the parents (1)

• individual meeting with an adult

• belonging to the group

• purposefulness, learning things guided by adults

• activities, trips

• positive feedback (rewarding, encouraging)

• participation of the whole family

• support, contact with school

Helpful things for parents in family rehabilitation (2)

• peer support

• coping with parenthood

• family day/weekend, actions together as a family

• clear action models for raising the children

• opportunity to ask advice, information of experts

• positive feedback

• support to change own behavior (self-control, etc.)

• regular meetings and discussions

What is now going on?

We collect data and evaluate:

• The situation at the beginning of rehabilitation, and after that by collecting the data of parents and children/ adolescents (11-15 year old).

• Co-operation between projects and their networks and the feasibility of different implementation.

Conclusions

The big questions are:

• Can we create a few “ideal” models of psychiatric family rehabilitation?

• What might be the roles of the Finnish Social Insurance Institution and the municipal services concerning psychiatric family rehabilitation in the future?