Elizabeth Fudge and Andrea ReupertCOPMI national initiative, Australia

AICAFMHA

(Australian Infant Child Adolescent and Family Mental

Health Association)

Australian Government

Department of Health and Ageing

Kylie Eddy, Chris Alliston, Darryl Maybery, COPMI Team

and Consultation Groups

Children of Parents with a Mental Illness - COPMI

Acknowledgements

Today

• Background to the Resource

– Why?

• Development

– How?

– Who was involved?

• Outcomes

– Who has used it and what do they think about it?

– Other lessons learnt

Background – Why COPMI?

• Approximately 23% of Australian children and

adolescents live in households where at least

one parent has a mental illness. Mayberry et al 2005

COPMI national initiative

Established in 2002, after a review of Australian services for children of parents with a mental illness and their families.

Aim: COPMI national initiative

To achieve better mental health outcomes for children of parents with mental illness

Children of Parents with a Mental Illness - COPMI

Children of Parents with a Mental Illness - COPMIChildren of Parents with a Mental Illness - COPMI

Consultation and Development of A ‘Principles and Actions’ Document

Children of Parents with a Mental Illness - COPMIChildren of Parents with a Mental Illness - COPMI

Booklets for families and a website

Availability of information for workers and

families

Access to quality workforce development

resources

Access to evidence and evaluation resources

Children of Parents with a Mental Illness - COPMI

Goals Since 2008(Early Intervention Services for Parents, Children and Young People)

Commitment to participation

• Dedicated staff member

• Budget for remuneration (e.g. time, child care travel)

• Consultation procedures and policies –

but multiple, flexible options for participation need to be in place

Why Workforce Development?Multi-component approach to prevention for

children of parents with a mental illness

Hosman & Van Doesum, Prevention Research Centre, Nijmegen

University 2000

Why Workforce Development?

In line with the

• National Practice Standards for the Mental Health Workforce (2002)

Recognised need to influence the attitude, knowledge base and skills of the Mental Health workforce

‘ When a worker asks me about my kids, or even just recognises that I'm a parent first, rather than a consumer of mental health services, that's the thing I appreciate. My family is the most important thing to me in my life. I just want to be treated like everyone else and given recognition that even when I'm unwell, I'm thinking and I'm acting in the best interests of my family. ’

Keeping Families and Children In Mind

Module 2

Why an e-resource?

• Accessible (by individual learners and by group facilitators) across vast distances

• Can tailor input to learner’s needs

• Interactive

• Consumer and carer informed

• Free, easy to use

• Funding

Development - Planning

• Literature review

• Consultation with 25 Australian providers

• Consultation with key stakeholders about content (Delphi study)

Consultation via secure wikis

Multiple designated participants can edit a simple webpage easily in their own time.

Enhances coordination as everyone can see the latest draft of a document, everyone can change that draft (saving it as the latest draft) and everyone can see each others comments on the document.

Can be used anonymously.

Consultation via wikis

Undertaking a Delphi study via a wiki to decide on key content areas for the e-learning resource (three rounds of questions) enhanced participation through

– Anonymity

– Accessibility

– Ease of ratingWhitham et al, 2009

‘ The unique thing about it was that even after people started using their own names there was no differentiation between a worker and a consumer/carer. This allowed everyone to feel safe with no pre-conceived ideas or discrimination regarding who they were.’

Participant quoted in Alliston, Kluge and Fudge, 2009

Development - Planning

• Findings

– Many would access it but ‘only if it matches face-to-face opportunities’

– Some MH workers prefer and/or have greater access to this medium than others

– ‘a range of practical, bureacratic, managerial and technological factors intervene’

Herrington and Herrington (2006)

Development of the Resource- matching a face-to-face experience

• Consultation group

• Lived experience group

• Working with producers

Development of the Resource- flexibility of use

• Content development in modular format

• Filming and audio taping – real life

• Scripts for reflective individual and group activities

• Engaging graphics

Development of the Resource- reduction of barriers to use

• Pilot testing in 2 states and in rural and urban settings with a mix of end users

• Working with those who may be able to influence uptake, e.g.

– professional ‘champions’

– state and territory government mental health departments

– workforce development facilitators

Endorsement

• Royal Australian New Zealand College of Psychiatrists

• Australian College of Mental Health Nurses

• Australian Psychological Society

• Australian Association of Social Workers

• Australian Association of Occupational Therapists

• Royal Australian College of General Practitioners

‘Keeping Families and Children In Mind’

• Available from www.copmi.net.au

• Free. Anyone can log in (families can also view the resource if they wish)

• A five-minute promotional video about the resource can be viewed at the COPMI website

6 Modules (approx 1 hour)

• Mental health and families

• The parent

• The child

• The family

• Carers

• Putting it into practice

Outcomes – Lived Experience

‘Throughout the whole process I have been proud to be involved.... I am excited that the whole process has included and valued my contribution. I want everyone to know that COPMI have not been tokenistic at any time; they have actually been bold and insightful by including not only professionals but consumers and carers.’

Consumer from the ‘Lived experience group’

quoted in Alliston, Kluge and Fudge 2009

Outcomes – Lived Experience

‘This resource is of an amazing standard. I feel immediately ‘plugged in’..... The acting in the fictitious case scenarios was just magnificent.’

Peer educator, 2009

Who has accessed it to date?

What roles do they have?

Carer Consultant; 16

Clinician/Practitioner; 195

Consumer Consultant; 12

Manager; 13

Other; 78

Researcher; 4

Workforce Educator; 51

Primary Professionals Completing 1-6 modules (total = 369)

Where are they located?

10

1 2

46

2118

12

1 2 3

67

11

21 22

31

22

1

9

1

8

55

18

1

13

0

10

20

30

40

50

60

70

80

Metropolitan Other Regional Remote Rural

Current Professionals Undertaking Modules 1 to 6 (Total = 369)

General Medical Practitioner

Mental Health Nurse

Occupational Therapist

Other

Psychiatrist

Psychologist

Social worker

Initial Evaluation Pilot evaluation conducted in 2009 at a rural and urban site

– Focus group interview with participants

– Pre and post questionnaire responses

– Facilitator journals (to gauge planning and implementation issues)

Reupert et al, (in press). Child and Family Social Work

Pilot evaluation – focus groups

– Participants valued the interactivity of the resource and life like depiction of families;

...it holds your attention much more than just reading...it brings it [the issues] to life

– Described a heightened awareness of needs of family and collaboration;

I think what’s come out of it was the importance of everyone who’s working with that family, working together...

– Recognised a range of possibilities for implementation (e.g. staff induction, )

A/Professor Kim Foster analysed focus group data

Participant response:

‘ As a participant I was engaged throughout, and really appreciate the extensive lists of references and resources. The variety of modes of presentation – words, voice, video and assessment tasks worked well for me. The actors portraying the two families are very believable and the children, parents and families who directly describe their experiences offer so much.’

CAMHS worker

Pilot evaluation – pre and post questionnaire

27 participants (20F/7M) completed identical pre and post training questionnaires that assessed change in participant confidence, knowledge and skill when working with the parents, children and families (Maybery & Reupert, 2006)

Post data show an improvement in participants’ knowledge, skill and confidence. Almost half of the 26 items showed a significant change, in the desired direction.

A/Professor Maybery analysed the questionnaire data

Pilot evaluation – facilitator journals

Facilitators report:

• Need to have reasonable proficiency in technology (or access to others who do);

• The family videos were a powerful and effective way to encourage participant discussion and reflection;

• Need to have appropriate group processing skills.

Implementation Evaluation2010-2011

• Design

– Pre, Post and 6 month follow up

• Family focused mental health practice questionnaire (33 item evaluation version Maybery, Reupert & Goodyear, 2010)

– 8 Subscales eg Skill and knowledge, Confidence, Interprofessional collaboration

– Also demographics

– Post test – what, how did they use the resource

• Online and hard copy

• Data so far Pre – n=120, Post – n=21, Followup – n=3

Range of Learner InteractionsExamples

• Blocks of 2 - 3 hours over 3 days

• Each of the six Modules seemed to take approximately four hours each as I worked diligently to follow links to References, Resources, listened to Audio, watched Video, filled in text for interactive boxes and did the Quiz at the conclusion of each section.

• Worked through each module over consecutive weeks. 2.5 hrs each module

Range of Learner Interactions

Examples continued

• I completed each module over many weeks/months to allow time for reflection and integration into practice.

• I completed the modules over two working days

• I worked through each module individually . The first took an hour and a half and then 1 hour each after that. I mostly did it at home in the evenings

• All in one day, took a break between modules

Access to Lived Experience

• Consumer and carer participants in the room with you as you are learning is very powerful.

• Where this can’t be achieved or would be potentially stressful for the consumer or carer, (especially children), video and audio clips can be very powerful.

• Can also be more time effective.

Lived Experience

Elizabeth Fudge

fudgee@aicafmha.net.au

Andrea Reupert

andrea.reupert@monash.edu

www.copmi.net.au