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

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 Task Objectives 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.

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 typen% Child guidance and family counselling centre519 Specialized outpatient clinics20736 Psychiatric clinic for children108 Neurological clinic for children47 Psychiatric clinic for adolescents52 Health Centre12221 Private doctor539 School10518 Others407 Total578100

10. Mental problems of the children and adolescents, % (ICD 10) 5-11 yr12-26 yr Neuropsychiatric disorders 4028 Anxiety disorders 1521 Disorders of conduct and emotions 2118 Depressions 514 Socioeconomical and psychosocial problems 66 Learning difficulties 85 Others 57 Total 100 Total 19 26 16 20 7 3 9 100

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?

18. Specific diagnoses of children /adolescents (n 578) * Asperger7914% * ADHD (Attention Deficit Hyperact. Disorder) 7313% *Tourette11 2% -Conduct disorders32 6% -Mixed disorders of conduct and emotions7313% <Anxiety (panic, anx. onset to childhood)7513% <Phobic anxiety disorders13 2% <Obsessive-compulsive disorder 7 1% <Adjustment and stress disorders28 5% Depression79 14% Socioeconomical and Psychosocial Problems37 6% Learning Difficulties31 5% Others (epilepsy, diabetes, drug, obesitas) 40 7%

19. Mental health services in Finland (1) Municipalities are responsible for arranging metal health services Outpatient services are provided by health centres, mental health offices connected with them and psychiatric hospital outpatient departments Institutional care is provided in the psychiatric units of hospitals. Service accommodation for mental health rehabilitees is in between outpatient and institutional care. Psychiatric rehabilitation division of labour between primary care, spezialized medical care and social services > rehabilitation plan with the rehabilitee.

20. Mental health services in Finland (2) The Social Insurance Institution (SII) reimburses psychotherapy fees incurred by over-16s who are threatened by incapacity to work or study, or who are unable to return to employment or studies without the support of psychotherapy For under-16s SII places importance on organising a diversity of family-oriented rehabilitation.