Steps Toward Evidence-Based Practices for Parents
with Mental Illness and their Families

Introduction

Millions of adults in the United States are affected by mental illness (U.S. Department of Health and Human Services, 1999). The majority of these men and women are or will become parents (Nicholson, Biebel, Hinden, Henry, & Stier, 2001; Nicholson, Nason, Calabresi, & Yando, 1999). Despite the prevalence of parenthood among adults with mental illness, mental health systems have traditionally served individual adult and child patients through categorical funding streams that do not allow for family-focused services for adults with mental illnesses and their children, or for services for the parents of children with serious emotional disturbance who may have mental health issues (Nicholson, Geller, Fisher, & Dion, 1993). Pervasive stigma and realistic fear of losing custody of their children have contributed to the "invisibility" of parents with mental illness as well as their children.

Over the last decade, sympathetic providers, who could not deny the reality of their clients' lives and who recognized the power of family roles and relationships, joined with consumers, mental health advocates and scholars to bring attention to this issue. There is increasing awareness that parents comprise a large subgroup of adults receiving mental health services, and that parents require specialized services to meet their needs (Cook & Steigman, 2000; Mowbray et al., 2000, 2001; Nicholson & Henry, in press; Nicholson, 1996; Nicholson et al., 1998a, 1998b). In some cases, increased awareness among policy makers and providers has led to the availability of funding and the development of innovative programs for parents with mental illness in the United States and elsewhere (Cowling, 1999).

This step is exciting and hopeful. However, there are many more steps to be taken. Few states have explicit policies regarding parents with mental illness (Nicholson et al., 2001) and none, to our knowledge, provide guidelines for interventions with parents and families. Programs for parents have generally been developed on a small, local scale with limited funding, and have remained largely isolated from one another. As a result, we knew little until this point about programs for parents or their impact on outcomes for adults and children. We did not know how many programs exist, or where they are located. We did not know whether programs reflect similar or divergent developmental histories, theoretical orientations, structural organization, funding streams, practices, or outcomes. We did not know whether programs are effective, and whether particular programs or practices can be identified as more effective than others, or more effective under certain conditions with particular families.

Before conclusions can be drawn about practices for parents with mental illness and their families, the development of an empirically supported evidence base is necessary. Rigorous evaluation requires systematic, standardized description of target population, program practices, and the theoretical relationship between clients served, practices and desired outcomes (Mueser et al., in press). Treatments must be shown to improve outcomes that are meaningful to participants, and that are measured objectively in research conducted by independent investigators (Mueser et al.).

Our goal was to take the next steps toward evidence-based practices for parents with mental illness and their families by identifying and systematically describing existing interventions. We report data from two studies designed to facilitate, ultimately, the rigorous evaluation of interventions. In the first study we identify programs and conduct in-depth telephone interviews with administrators and providers to describe, compare and contrast programs along selected dimensions. In the second study we define explicit logic models with hypothetical links between target populations, practices, processes, and outcomes for selected programs, using data obtained in comprehensive site visits. These are the necessary next steps in creating an evidence base.

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Steps Toward Evidence-Based Practices for Parents with Mental Illness and their Families

Introduction

Steps Toward Evidence-Based Practices for Parents
with Mental Illness and their Families