While we all strive to ensure positive mental health and well-being for ourselves and our families, mental health conditions affect most households at some point, directly or indirectly. Children are no exception, with an estimated one in five schoolchildren living with mental health, behavioural or neurodevelopmental disorders.1Ann Douglas, Parenting Through the Storm (Toronto: HarperCollins, 2015).
Both early intervention and quality, evidence-based care are essential to supporting children with these conditions and building their resilience. For some families, however, it isn’t always possible to access face-to-face intervention services. Lengthy clinic wait times, fear and/or experience of stigma and long travel distances can make it challenging to access appropriate services.
This can be particularly true for military families, in which a parent may have unpredictable schedules that often involve a greater amount of travel, separation, routine disruptions, transitions and overall stress than their civilian counterparts. Due to their high mobility and frequent moves, military families also commonly experience difficulties maintaining continuity of care for their children.2Heidi Cramm et al., “The Current State of Military Family Research,” Transition (January 19, 2016), http://bit.ly/23cpyut.
Flexibility can facilitate mental health care for families
Clinic-based mental health services offer a variety of programs and supports to youth, but many lack the flexibility that families require to support these children while managing other family and work responsibilities. Children’s school schedules often don’t align with available mental health services, and repeated absences due to the need to attend regular appointments at a clinic can have an impact on children’s academic performance and their social relationships with friends and peers.
It may also be difficult or impossible for many parents to take the necessary time off work to bring a child to face-to-face appointments, either because they lack the necessary flexibility at work or because doing so would incur financial hardship. Nearly 7 in 10 couple families with at least one child under 16 have two employed parents, and in three-quarters of these couples, both parents work full-time.3Sharanjit Uppal, “Employment Patterns of Families with Children,” Insights on Canadian Society (June 24, 2015), Statistics Canada catalogue no. 75-006-X, http://bit.ly/1Nen7gR. For single-parent families, the impact of missing work to accommodate appointments can be particularly difficult. Flexibility can be all the more important when seeking support for their children in military families, which often experience high mobility and deployments.
The Strongest Families Institute provides family-centred mental health care
Founded in 2011, the Strongest Families Institute (SFI) is a not-for-profit corporation designed to provide flexible, evidence-based and stigma-free mental health support to children customized to their needs and family realities. Based on six years of research at the Centre for Research in Family Health at the IWK Health Centre in Halifax, Nova Scotia, SFI programs and modules are now accessible across the country. SFI has been nationally recognized for social benefits by the Mental Health Commission of Canada (2012) and was the recipient of the Ernest C. Manning Encana Principal Award (2013).
SFI programs use a family-centred approach, directly engaging and involving family members throughout the process. Families can play a powerful role in facilitating quality mental health care because of their familiarity with the child’s circumstances. They also have a unique ability to provide valuable feedback to service providers throughout the engagement process.
Developing skills to build resilience… from a distance
SFI programs are focused on skill-based learning that fosters mental health and resilience skills through the use of psychologically informed educational modules that help families manage behavioural conditions or difficulties (e.g. not listening, temper or anger outbursts, aggression, attention deficits or hyperactivity) and anxiety (e.g. separation, generalized, social, specific fears).
SFI employs a unique distance coaching approach, utilizing technology to directly support families over the phone and the Internet in the comfort, privacy and convenience of their own home.4Patricia Lingley-Pottie and Patrick J. McGrath, “Telehealth: A Child-Friendly Approach to Mental Health Care Reform,” Journal of Telemedicine and Telecare 14 (2008): 225–26, doi:10.1258/jtt.2008.008001. Research has shown that distance coaching can result in significant diagnosis decreases among children with disruptive behaviour or anxiety conditions.5Patrick J. McGrath et al., “Telephone-Based Mental Health Interventions for Child Disruptive Behavior or Anxiety Disorders: Randomized Trials and Overall Analysis,” Journal of the American Academy of Child and Adolescent Psychiatry 50, no. 11 (2011): 1162–72, doi:10.1016/j.jaac.2011.07.013.
“[My coach] has taught me a lot of skills that I was not aware of – especially in the conditions of the ever-changing military family life situation – and helped us deal with a lot of challenges. [My child] is more patient and approachable now. He knows how to deal with stress when his father is away [deployed]. His grades and behaviour at school have improved as well, he has fewer outbursts and the teachers have noticed the difference as well.”
– Parent of a 9-year-old participant in the Active Child program (Behaviour)
SFI’s Parenting the Active Child Program focuses on child behaviour for ages 3 to 12. In this program, parents and their children work together to create structured plans to help manage specific challenges a child may experience during particular times or activities. For example, parents and children can work together to develop a plan to make outings such as a trip to the grocery store or long trip in the car more enjoyable by using program skills. Through this simple but structured and guided approach, parents together with their children and the coach can work toward and reward good behaviour. By using the family home as a base for learning rather than a clinic setting, many of the issues of stigma are avoided. Families receive a series of written materials and skill demonstration videos, delivered either through handbooks or by smart-website technology, which teach one new skill per week to implement as part of their daily living activities.
The SFI anxiety program for 6- to 17-year-olds, Chase Worries Away, helps family learn life skills to defeat worries such as separation anxiety, performance issues, social anxiety and specific fears that are commonly related to the challenges of military life. SFI also runs a program for children ages 5 to 12 called Dry Nights Ahead, which helps with nighttime bedwetting.
Coaches ensure stability and guidance throughout the program
Children and families are supported and guided throughout the SFI programs by highly trained and monitored coaches. These coaches engage in structured weekly telephone calls that follow protocolized scripts, complementing the material families receive. During each session, the family’s coach reviews the skill that has been developed throughout the week and uses evidence-based strategies, such as role-playing and verbal modelling, to practise the skills and assess progress.
Schedules are flexible and customizable to accommodate families regardless of where they are located or where they move. This flexibility and focus on distance coaching can be particularly valuable for military families, bridging the geographical divide during separations resulting from postings so that the continuum of care is maintained. Moreover, during a posting, coaches help the families plan for the transition and they remain available during and after to encourage the maintenance of skills. This focus on planning supports families during potentially disruptive transitions, such as during a change of school or daycare.
The coach can be a familiar, centralized contact/support for the family, regardless of the move location. Coaches have high military literacy – understanding of the unique experiences of military families and the “military life stressors” that can have an impact on military families, such as high mobility, extended and/or unexpected separation and risk. Care and support is customized to the realities and needs of each family.
“[The program] helped me quite a bit, especially in everything anxiety, I still have other issues, but in terms of anxiety it has become less of a problem for me, socially, being independent, things I wouldn’t have done before, school stress has reduced quite a bit. They were the main things I was focused toward, and this has decreased stress for me.”
– 16-year-old participant in the Chase Worries Away program (Anxiety)
Transferable learning: Flexible support for diverse and unique families
SFI programs have demonstrated success, with families reporting high satisfaction. Rigorous testing and randomized trials show positive outcomes, with lasting effects one year later, targeting mild and moderate conditions. Programs have been found to have an 85% or better success rate in overcoming the child’s presenting problems, with an attrition rate of less than 10%. Data shows a strong impact on strengthening family relationships, parental mood/stress scores and child academic performance.
Families and their children are unique, and there is no “one-size-fits-all” solution to manage mental health or behavioural or neurodevelopmental disorders. Flexibility in SFI program design and availability can enhance the use and effectiveness of mental health supports, since families can receive support outside of traditional clinic settings and schedules. By using distance coaching and continued family support through structured calls with coaches, families engaged with SFI can receive care that is flexible, effective and respectful of their experiences and realities.
About the Strongest Families Institute
The Strongest Families Institute (SFI) is a national, not-for-profit organization that delivers distance, evidence-based programs to children and families who face issues impacting mental health and well-being. Founded in 2011, SFI seeks to provide timely delivery of services to families when and where they are needed by using technology, research and highly skilled staff.
Over the years, SFI has formed many partnerships to improve its services. Some of these partnerships have helped them deliver services to military and Veteran families, including Military Family Services – Ottawa, Bell True Patriot Love Foundation (Bell Let’s Talk) and a project collaboration with CIMVHR.
To learn more about the Strongest Families Institute, visit their website or see their page in the Vanier Institute’s Military and Veteran Families in Canada: Collaborations and Partnerships Compendium.
Published on Tuesday, September 27, 2016
Notes [ + ]
1. ↑ Ann Douglas, Parenting Through the Storm (Toronto: HarperCollins, 2015). 2. ↑ Heidi Cramm et al., “The Current State of Military Family Research,” Transition (January 19, 2016), http://bit.ly/23cpyut. 3. ↑ Sharanjit Uppal, “Employment Patterns of Families with Children,” Insights on Canadian Society (June 24, 2015), Statistics Canada catalogue no. 75-006-X, http://bit.ly/1Nen7gR. 4. ↑ Patricia Lingley-Pottie and Patrick J. McGrath, “Telehealth: A Child-Friendly Approach to Mental Health Care Reform,” Journal of Telemedicine and Telecare 14 (2008): 225–26, doi:10.1258/jtt.2008.008001. 5. ↑ Patrick J. McGrath et al., “Telephone-Based Mental Health Interventions for Child Disruptive Behavior or Anxiety Disorders: Randomized Trials and Overall Analysis,” Journal of the American Academy of Child and Adolescent Psychiatry 50, no. 11 (2011): 1162–72, doi:10.1016/j.jaac.2011.07.013.