Forgotten children : which problems with the first italian experience ?

1. Forgottenchildren: whichproblemswith the first italianexperience? I. Brusa , A.Cerri, E.Re, F.Tasselli XI WAPR World Congress Milano 10-13 november 2012

2. Whyprevention? PREVENTION IS MORE EFFECTIVE AND ECONOMIC THAN WAITING AND TREATING PSYCHOLOGICAL PROBLEMS OF THE CHILDREN WHEN THEY APPEAR Shochet et al 2001 Associazione CONTATTO Onlus Milano

3. THE ILL PARENT • is absorbed by his thought and emotions : can’t put attention to people around him • “I don’t know to do with the baby”, “I can’t do anything” : feeling of inadequacy • “before I was fine, he’s the cause of my problems”, “he scares me” : feeling of the baby as a problem for him • “all is ok “, “all is going worse” : loss of the critic, he’s hypo o hypercritic

4. THE CHILD • “mom doesn’t care me because I’m bad” : feeling of guilty • “I don’t know what I’ve to do”, “I can do it by myself”: feeling of impotence or omnipotence • “these homework are necessary, if I don’t do them, nobody does” : he charge himself of too much responsibility • “I’ve to protect my mom “, “ I must keep the secret” : he develops two identity levels

5. Children experience can include • I’m the cause of the problems, and my father doesn’t love me anymore • if I were different , all could be better • I hate my parents ! Parent experience can include • I’m not good father/mother • If I were not here, all could go better • How many trioubles with the children ! Professional experience can include • Poor child ! what kind of parents !! • My little patients have not to suffer cause the parents ! Tytti Solantaus, 2010

6. “Little flowers in Sesto” (PiccoliFiori in Sesto) • starting from Adult Mental Health System • a pilot project took place from 2010 to 2011 • in Milano by NGO “Contatto Onlus ”, in partnership with Adult and Child Mental Health Services of Sesto S.Giovanni • 6-14 y.o. children of adults treated by the local adult CMCH • The aim : to evaluate and increase protective factors and the relationships in and out of the family, using a natural social networks activation approach Associazione CONTATTO Onlus Milano

7. expectedresultsand outcomesachieved: In the Sesto San Giovanni CMCH: 26.4% of patients between 25 and 55 years old, (A.V. 97) had children under 18, so we expected to be able to include a high number of families. On the contrary we received from the service just 16 referrals and we were able to treat just 6 families. Associazione CONTATTO Onlus Milano

8. Professionals referred only high pathological families We couldn’twork following a perspective of prevention Associazione CONTATTO Onlus Milano

9. This result was probably the effect of culture of care in mental health services: • the focus on the adult patient picked out from his environment • the attitude to consider some patient abilities (like occupational or domestic skills), neglecting parental competences • the fear of stigmatizing the patient • the supposed risk of interference in the therapeutic relationship • the offer of the program was focused on the child social network and not addressed to the whole family Ass CONTATTO Onlus Milano Moreover:

10. Semola Program • After a specific training and after going deeply in the literature, we conceived a new preventive project, that will take place in 2013 and 2014 • It will be realized in Milano by Contatto Onlus”, in partnership with Adult Mental Health Services of Niguarda Ca’ Granda and San Carlo Hospitals and La Tartavela, association of family members. • it is funded by the Municipality of Milan Associazione CONTATTO Onlus Milano

11. the program has been refocused and reshaped in order: • to extent the intervention to the whole family • to extend the recruitment to a larger population we agreed with CMHC professionals a strict procedurein order to cooperate to recruit all the recruitable families, keeping the difference between CMHC professionals and the special team in terms of competence and roles Associazione CONTATTO Onlus Milano

12. approach • We will follow the Finnish approach of T.Solantaus (Let’s Talk intervention, Family Talk Intervention, Vertti Group) • We will also maintain our traditional intervention on the natural social network of the child • We involve family member associations , but for the moment we choose not to formally involve other services or the general population Associazione CONTATTO Onlus Milano

13. Flow chart – Semola program FIRST NURSE INTERVIEW TARGET: Every new patient with children 6-14 FIRST INTERVIEW (PSYCHIATRIST W COWORKER) c LET’S TALK (1 - 3 sessions ) (CW WITH A TRAINED PSYCHOLOGIST) Associazione CONTATTO Onlus Milano FAMILY TALK INTERVENTION VERTTI GROUP No otherintervention NATURAL SOCIAL NETWORK ACTIVATION

14. TENDENCIES AND PROBLEMS OF SERVICES …IGNORANCE, FEAR, ABSTINENCE !!! • not to consider children problems • fear to stigmatize their patient as bad parent • fear to ruin the relationship with the pt • to consider this problem not as a competence of adult psychiatry, but of infant psychiatry • formally correct, but altogether inadequate cooperation among services involved (health/social, adult/infant, hospital/clinics) • weak services system governance and no mandatory preventive programs by health local authority or health/welfare ministry

15. TOWARD A MULTILEVEL AND MULTITASK INTERVENTION

16. Stop thinking that talking about problems could be dangerous !! TALKING ABOUT PROBLEMS LET PEOPLE BE BETTER !!!! Don’t wait !! TO PREVENT IS BETTER THAN TO TREAT !!!!