Content

1. 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

2. 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

3. 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.

4. Rovaniemi Oulu Kokkola Kajaani Kuopio Seinäjoki Jyväskylä Tampere Yläne Kotka Turku Helsinki Project locations

5. 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

6. Evaluation TaskObjectives and Data Objectives of evaluation of 11 family rehabilitation projects (2006-2009): • Description of the implementation models of the projects • Description of the target group (children and adolescents) • Outcomes of family rehabilitation at the individual and family level • 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.

7. 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.

8. Children/adolescents (n 578) from the year 2006 Figure 1: Gender by age

9. Referrals of the children and adolescents to family rehabilitation Referring organisation type n % Child guidance and family counselling centre 51 9 Specialized outpatient clinics 207 36 Psychiatric clinic for children 108 Neurological clinic for children 47 Psychiatric clinic for adolescents 52 Health Centre 122 21 Private doctor 53 9 School 105 18 Others 40 7 Total 578 100

10. Mental problems of the children and adolescents, % (ICD 10) Total 5-11 yr 12-26 yr Neuropsychiatricdisorders 40 19 28 15 26 21 Anxiety disorders Disorders of conduct and emotions 21 16 18 Depressions 5 20 14 Socioeconomical and psychosocial problems 6 7 6 8 3 5 Learning difficulties 5 9 7 Others Total 100 100 100

11. 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

12. 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

13. Changes in the children and adolescents reported by the parents Families (n=66) %

14. 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

15. 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

16. 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.

17. 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?