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Steps Towards Evidence-Based Practice in Supporting Families Affected by Parental Mental Illness
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The Provincial Working Committee Chairperson Dr. Robert Lees, Ministry for Children and Family Development |
The First Forum in 1998
In 1995 the Gove Inquiry came out and told Matthew’s story (see Appendix A). This inquiry led to a sharp rise of children taken into care. The committee wanted to look at this practice and attempt to determine best practice for working with these families. The first project initiated by the committee was a half-day forum held on September 30, 1998 at the Vancouver Public Library. At the time, with the children in these families as the focus, this first forum was called “Children Whose Parents Have Mental Illness: Building Best Practices to Support Families in British Columbia”. Approximately 150 stakeholders attended.
The Second Forum in 1999
The enthusiastic response from that event demonstrated to the Working Committee that forums are an effective means for advancing the field. This understanding led to the second provincial forum on September 30, 1999 at the Roundhouse Community Centre in Vancouver. This forum added the word “Parents” to the title and was called “Children Whose Parents Have Mental Illness: Building Best Practices to Support Families in BC”. This forum was made possible through funding provided by the Ministry of Health and the Ministry for Children and Families, as well as contributions of time and materials from Family Services of the North Shore, the Canadian Mental Health Association, BC Schizophrenia Society, Greater Vancouver Mental Health, the BC Council for Families and Mheccu (UBC).
Nearly 300 people from all areas of the province attended this forum to hear from leading researchers in this field and to consider personal and professional experiences in an effort to develop better responses to families with parental mental illness in British Columbia. Leah Hollins, Ministry of Health gave opening remarks. The keynote addresses were presented in the morning by Dr. Judith Cook, University of Chicago at Illinois on "Parenting Through a Mental Illness - the Needs of Parents" and Dr. Diane T. Marsh, University of Pittsburgh at Greensburg on "The Needs of Children Who Have a Parent with a Major Mental Illness." An afternoon panel of speakers shared their personal perspectives as adult offspring, and as parents who have a mental illness.
Following the panel, participants broke into discussion groups of 10 to 12 members to respond to directed questions regarding what could be done to promote best practices in, BC. The discussion groups were organized by region and included members from a range of backgrounds, including adult mental health workers, child/youth mental health workers, child protection workers, educators, public health workers, mental health consumer and advocacy groups, family service organizations and community services. The regions were: Victoria; Mid Island (Nanaimo, Duncan, Port Alberni); Vancouver Island (Parksville, Campbell River, Port Alberni); Vancouver; Surrey; Simon: Fraser Region; Upper Fraser Valley; Richmond; North Shore, Sechelt, Powell River; East/West Kootenays; Kamloops; Okanagan; and the North.
Dr. Cinder Woods, Senior Mental Health Consultant to the Ministry, conducted a final “roll up” session for Children and Families. Mike Corbeil, Deputy Minister for Children and Families, made closing remarks. Dr. Rob Lees acted as host and MC for the day. Following this event there was a Record of Proceedings put together by Sharon Van Volkingburgh that documented the forum, specifically the small group discussions.
The Publication of Manual in 2001
From these two important forums a manual was developed by the provincial working group for community education and planning. The manual was pilot tested in Chilliwack and North Vancouver. In 2001 the Supporting Families with Parental Mental Illness Working group published the “Supporting Families with Parental Mental Illness: A Community Education and Development Workshop. A training Tool for Communities to Organize Services to Support Families.” It provides an outline for any community to hold an event for the purposes of planning for families with parental mental illness. This training tool includes basic information on mental illness and information on parental mental illness from both the adult and the child’s perspective. It also includes a process for Community Development, information on advance planning in the form of the Ulysses Agreement, and the Best Practices Checklist that communities can use to set goals for responding to the needs of this population. The members of the Working Group at that time were: Dr. Robert Lees, MCFD, Desiree Blume, FSNS, Lyne Brindamour, FSNS, Dr. Nicole Chovil, Hylda Gryba, MCFD, Eric McNaughton, CMHA-BC, and Sharon Van Volkingburgh, CYMH. This document is available at: www.mcf.gov.bc.ca and www.bcss.org. Since publication, numerous communities around the province have used the manual to guide a planning process including: Abbotsford, Agassiz, Mission, Langely, Surrey, Delta, Maple Ridge, Burnaby, Victoria, Saltspring Island and upcoming in Kelowna.
The Publication of Visions Magazine in Spring 2004
In 2004 several members joined the group: Ruth Hess-Dolgin, VCHA, Doris Bodnar- BCWRMH and Catherine Hume, CMHA-BC. In the spring, many members of the Provincial Working Group contributed to a special edition of Visions Magazine: BC’s Mental Health & Addictions Journal that focused on parenting. This magazine is a wealth of information about families with parental mental illness.
Shortly after this, the group began meeting again. Based on past experience, they knew forums were an effective way to make advancements and kick-start a process of change, so they decided that after five years it was now time to start planning for another forum.
The Third Forum in 2004
On December 3, 2004 the Provincial Working Group hosted a forum on “Steps Towards Evidence-Based Practice in Supporting Families with Parental Mental Illness” in Vancouver, BC at the Masonic Hall. The title of this forum shows the progression made to a focus on the family rather than an individual part as was done previously with the focus on the children. The goal this time was again to increase awareness and improve policy, protocol, practices and programs for these families.
Method
Telephone Interviews
Before the forum, a number of people were interviewed in order to gather some initial information to prepare for the forum. Each person was sent an email request for an interview, including the questions (see Appendix B). They either accepted, declined, or suggested another name that they felt would be more suitable. Several members of the Working Group chose the people to interview and all came to a consensus on who would be contacted. All interviewees were guaranteed anonymity. They were from all over British Columbia and had specific interest in working with families with parental mental illness. The results of these interviews were presented in a general manner at the forum with no names or identifying features of the interviewees being mentioned. Those comments are also included in this document.
The Forum
The forum on December 3, 2004 was planned with the purpose of establishing a new baseline of services in British Columbia, evaluating where we were in terms of policy, practice, programs and protocol and setting a new vision for our province. This work is the first initiative of its kind in Canada, something that has nationwide implications. A scan of other jurisdictions such as Australia and the United States convinced the working committee that this work in supporting families with parental mental illness was at the leading edge in integrative health care.
There were over 100 attendees from diverse backgrounds who sat together for the day. Honourable Brenda Locke, Minister of State for Mental Health and Addiction Services brought greetings. The keynote speaker was Dr. Joanne Nicholson. She has been a clinical and research psychologist for over twenty years and is Associate Professor of Psychiatry and Family Medicine at the University of Massachusetts Medical School (UMMS), and Deputy Director of the Center for Mental Health Services Research. Dr. Nicholson writes extensively on parents with mental illness, and provides training and consultation to professional and consumer groups.
In the morning and in the afternoon, the attendees met in small groups to discussthe ultimate purpose of the 2004 forum: to bring together a collective voice and community to help and support families with parental mental illness. Each session lasted approximately 45 minutes. The attendees were instructed that the morning session was meant to discuss what was currently happening in British Columbia and the afternoon session was to discuss their visions or what they hoped would happen for families with parental mental illness. This researcher explained that the findings would be organized under four headings: Policy, Protocol, Practice and Programs. Participants were given specific examples for each of the four headings based on the telephone interviews conducted before the forum occurred (See Appendix C).
The attendees were told that the notes taken from the small group sessions would be put into a document of findings from the forum. They were also told that at the last forum five years ago, the notes taken led to a number of publications and had a direct impact on practice.
Ten professionals known to the working group were asked to act as facilitators and ten service providers and students to act as recorders. The recorders were asked to type up the notes they took and email them to the researcher. These notes were used to write the findings from the forum. The facilitators were: Janet Ashdown, VCMHS, Rehabilitation and Recovery, Gloria Baker, VCMHS, Mary Lee Best, VCMHS, Dr. Simon Davis, VCMHS, Brooke Heximer, Coast Foundation Society, Mimi Hudson, FSNS, Catharine Hume, CMHA-BC, Otto Lim, Vancouver Coastal Health, Jeri-Lyn Ratzlaff, CMHA, Dr. Rajpal Singh, VCMHS. The recorders were: Steve Barker, City University Student, Jane Duval, BCSS, David Grice, TWU Student , Jennifer Ivey, SFU Student, Darlene Jamieson, MCFD, Maryann Koot, TWU Student, Zoe Paris, UBC Student, Sherisse Poirier, UBC Student, Rob Taylor, TWU Student, Kate Walters, TWU Student. One recorder who did not send me their notes, so one group was not represented in the findings.
The forum organizers constructed groups of 10 to 12 members. Each group had attendees from a range of areas. For example, one group consisted of a Manager of Mental Health and Addictions, a Deputy Director of Aboriginal Services, a Clinical Director of an Infant Psychiatry Clinic, a Regional Manager at Vancouver Community Mental Health Services, a Mental Health Consultant, a Child Protection Consultant from MCFD, someone from the Centre for Addictions Research of BC at University of Victoria, a Clinical Supervisor of an Aboriginal Wellness program, a Clinical Associate at another local University and two consumers, one a child of parents with mental illness and the other a parent with a mental illness. The groups remained the same for the morning and the afternoon sessions.
Feedback
This researcher had contact with all facilitators and recorders before the forum. They were given guidelines and suggestions for how to facilitate a group, the group members they would be working with, the purpose of the forum, what it was hoped to be gained from the small groups and ultimately the notes that would be collected (see Appendix D). Organizers received informal feedback from the facilitators and recorders by talking with them during the day. Most of the groups reported to have run smoothly. The committee had concerns that the consumers would feel comfortable and would be given a voice in the small groups. In several groups the consumers dominated discussion to the extent that some of the other members did not contribute their thoughts and ideas. Several months after the event all ten facilitators were contacted by email and asked for written feedback about their experience as a facilitator. Three out of ten facilitators responded to the email request (see Appendix E). The feedback reported that the groups were a little large, that the diversity was somewhat effective, and that Ministry workers appeared to be somewhat hesitant to speak up.
37 attendees provided feedback about several different aspects of the day, including the small group discussions (see Appendix F). One person stated that the facilitators and recorders were excellent. Eight people commented specifically that they found the perspectives shared by the consumers were excellent. One person wrote, “I especially appreciated hearing from parents with a mental illness in our group and their perspectives on the questions.” Other people wrote that they appreciated the diversity of the groups and made comments similar to this person: “I appreciated the mixture of people from different backgrounds with different experiences and a broad range of resources.”
Of concern was that a number of attendees did not return for the afternoon session, therefore were unable to contribute to the small group discussions. The event was held on a Friday, a day where more people may be tempted to leave early and begin their weekends.
After lunch attendees had the opportunity to watch a play entitled, “My Own Private Etobicoke” written and performed by Eufemia Fantetti. An information sheet for this play states that “My Own Private Etobicoke is a moving, personal account about surviving schizophrenia as a family member. Every family has a secret; the Fantetti family tries to no avail to hide the fact that one of them has a serious brain disorder. Honest, humorous and insightful, My Own Private Etobicoke is a one-woman show about growing up in a home where chaos is a constant. Companion (see Appendix G). The feedback about this play was overwhelmingly positive. This comment is a representative example, “it was fantastic, moving, emotional, educational, enlightening and extremely well done. The woman who wrote and performed the play is talented and courageous. Thank you for bringing her to the forum.”
Collecting and Organizing the Data
This researcher collected all the notes sent by the recorders and organized the comments under the four main headings. Initially, many of the same points were placed under either Policy, Protocol or Practices so a decision had to be made which category they belonged. In several cases, a comment could be a policy decision but also fall under another category such as practice. In the final analysis, the findings could not always be clearly labeled under one category. Instead, a topic was discussed and it could be a point affecting one or more of the four headings. An original list of the comments made by attendees, as written by the recorders, untouched and organized under the four headings is available upon request.
The comments were included in the final report, under the section the author deemed appropriate. Each comment was taken as representative of all the participants. There was no process for tracking the number of times a point was made, thus if a comment was made once or was made a number of times, it was still put in the findings one time and was placed under a general comment such as “Some participants felt…” or “A participant commented that…”.
Vision
The Provincial Group has continued to meet since the forum and has made initial steps toward addressing some of the visions that have emerged from these findings. The hope is to take each vision formulated at the forum and find some way to make it a reality.
Shortly after the forum progress began to happen. Dr. Rob Lees and Ruth Hess-Dolgin met with the Directors of Child Welfare to seek funding from MCFD: Child Welfare, Service Transformation Branch and Headquarters in Victoria to sponsor 10 Community workshops in 10 communities in British Columbia in 2005/2006. The committee has received funding both to conduct the workshops and to engage in the research.
On February 23, 2005, Désirée Blume presented initial findings as part of a panel at a workshop held at the Chan Centre Auditorium at Women’s and Children’s Hospital. It was for service providers with the objective being to increase awareness of the needs of families where there is parental mental illness. It was put on by Vancouver Coastal Health (Addiction Services, Community Mental Health Services, Community Health Services), Ministry of Children’s & Family Development, and the Reproductive Mental Health Program. Eufemia Fantetti presented her play, “My Own Private Etobicoke.”
On March 23, 2005 Dr. Rob Lees, Ruth Hess-Dolgin and Désirée Blume met with Honourable Minister Brenda Locke to discuss the possibility of tracking the number of families with parental mental illness currently seeking services from the Ministries. They also requested funding to determine the feasibility of holding an International Conference on this topic in Vancouver (See Appendix H).
On April 29, 2005 Désirée Blume was the keynote speaker at Malaspina University in Nanaimo, BC where she presented her initial findings from the forum on December 3, 2004. In the next few months various members of the Provincial Working Committee will continue to meet with government to request that tracking cases starts to occur. A number of presentations of these findings are also planned including the Shared Care Conference in Ottawa in June 2005.
The remainder of this document will go over the findings from the third forum. The document includes research that supports the comments made by the participants at the forum as a way to provide background information, provide clarity on a point, and to show that researchers from around the world are also interested in the same issues that impact our British Columbian families with parental mental illness.