Skip Navigation
Service Delivery Innovation Profile

Intensive Case Management Aids Parents With Co-Occurring Disorders and Their Children, Leading to Healthy Families


Tab for The Profile
Comments
(0)
   

Snapshot

Summary

Mental Health America of Wisconsin's Strong Families Healthy Homes program (formerly known as the Invisible Children’s Program) takes a family-centered approach to helping low-income parents and their families cope with mental illness and substance abuse disorders. The program provides ongoing case management, education, and peer support. It is designed to reduce the stigma associated with mental illness, increase positive family interaction, and identify and address cognitive and behavioral problems in children. Adult participants experienced less mental health–related stigma and stress, gained parenting skills and social support networks, and had relatively few psychiatric hospitalizations. Family health was impacted through enhancing the children's access to services for cognitive and/or developmental delays and through many lasting family reunifications.

Evidence Rating (What is this?)

Moderate: The evidence consists of self-reported results from participating parents on levels of stigma and stress, parenting skills, and support networks. Surveys were completed at baseline (by 47 adults with 135 children) and after 6 months of participation (by 18 adults). Additional evidence consists of post-implementation data on connections to needed services for children, psychiatric-related hospitalizations while in the program, and reunifications among families temporarily losing custody of one or more children.
begin do

Developing Organizations

Mental Health America of Wisconsin
end do

Use By Other Organizations

The following Mental Health America affiliates are in various stages of program implementation:
  • MHA of Charlottesville-Albemarle, Charlottesville, VA
  • MHA of Columbia-Greene Counties, Hudson, NY
  • MHA of Greater Knoxville, Knoxville, TN
  • MHA in Passaic County, Clifton, NJ
  • MHA of the Southern Tier, Binghamton, NY
  • MHA of Dutchess County, NY
  • MHA in Passaic County, Clifton, NJ
  • MHA of Sacramento, CA
  • MHA of Southeastern PA
  • MHA of Texas

Date First Implemented

2001
begin pp

Patient Population

Vulnerable Populations > Children; Co-occuring disorders; Mentally ill; Substance abusersend pp

Problem Addressed

Children of parents with mental health and/or substance abuse problems face an increased risk of developing an array of problems, including being taken away from their families.1 Although most women with such problems are mothers, their children remain largely "invisible" in the adult behavioral health system.2 Few if any services are designed to help the entire family unless the child also has an official mental health diagnosis.3
  • Children at high risk: Having a parent with a mental health or substance abuse problem puts a child at high risk of developing cognitive, behavioral, and substance abuse problems.1 These children also face the risk of being taken away from their parents, with up to 48 percent of parents with mental illnesses losing custody of their children.4
  • Little or no support from behavioral health system: Although more than two-thirds of women with substance abuse and mental health disorders are mothers, few services target low-income families affected by these disorders.2 Similarly, few treatment programs address parenting issues or children’s needs unless the child has an official psychiatric diagnosis.3

What They Did

Back to Top

Description of the Innovative Activity

Mental Health America of Wisconsin's Strong Families Healthy Homes program (formerly known as the Invisible Children’s Program) takes a family-centered approach to helping families cope with mental illness and substance abuse. The program provides ongoing case management, education, and peer support. It is designed to reduce the stigma associated with mental illness, increase positive family interaction, and address cognitive and behavioral problems in children. The program aims to decrease psychiatric hospitalizations and to reduce child abuse and neglect. Key elements of the program are described below:
  • Multiple referral sources: Therapists, doctors, and child welfare workers refer parents with mental illness and/or substance abuse disorders to the program, with between one-half and three-fourths of those referred being involved in the child welfare system. Those referred to and enrolled in the program commit to creating a safe home environment for their children (or child).
  • Family needs assessment: Trained case managers (known as "Family Advocates") meet with families, using a formal, research-based tool to assess their needs related to housing, medical care, mental health care, employment, legal issues, and school. Information provided in September 2013 indicates that Family Advocates either have a clinical license (LCSW, LPC), or are receiving clinical supervision towards clinical licensure. Family Advocates also provide individual therapy to parents and engage in therapeutic interventions with the family as a whole. Families generally progress through three tiers of case management services that include 24-hour access to emergency services and support for children when a parent becomes hospitalized. The program also offers transportation to and from sessions and childcare during the out-of-home activities.   
    • Intensive phase (Tier 1): For the first 8 to 12 months, family advocates generally provide 10 to 16 hours of inperson service per month that includes ongoing case management. Families can also call the advocate as needed. During these contacts, advocates help families apply for supplemental security income and connect them with legal, school, and mental health providers. Other case management services may include mentoring, advocacy, parent skills training, family playtime activities, and support groups. These services aim to prevent child neglect, abuse, infant mortality, childhood injuries, and future mental illness. Parents also participate in a 8-week Wellness Recovery class (2 hours every week) that covers diagnoses, medications, and signs and symptoms of mental illness, as well as a 12-week Parenting Through Mental Illness class that uses a nurturing parent curriculum. Once a month, families come together for a "family night," during which parents complete a crisis plan to help them create goals for moving their families forward. Empowerment plans are developed to address family goals, including parenting and mental health. These plans are reviewed periodically with families during both tier 1 and tier 2 levels of service.
    • Intermediate phase (Tier 2): Families may move on to the second phase when both program leaders and staff at the Bureau of Milwaukee Child Welfare Department believe they are ready; generally after completion of both the Wellness Recovery and Parenting Through Mental Illness class. The intermediate phase consists of less-intensive case management support designed to help during transition, for example, when parent(s) who have lost custody of their children are moving towards reunification. During this phase, advocates conduct home visits at least twice a month and also check in weekly over the phone. Families continue to participate in monthly family nights.
    • Transition toward independence (Tier 3): This phase is often reached after parents have been reunited with their children and/or after the child welfare team decides a family no longer needs ongoing case management support. The Specialized Family Center offers families mentoring (linking similar families with each other), advocacy services (around parental rights and custody loss), and connections to community resources and events.
  • Peer mentor support: Peer mentors who are successful graduates of the program provide ongoing support to clients by running weekly parent support groups on Wednesday mornings, periodically checking in via telephone with program participants, and meeting with parents individually as necessary.

Context of the Innovation

Lucinda Sloan Mallen, the Executive Director of Mental Health America in Orange County, NY, provided the impetus for the development of the program. The child of a single mother with bipolar disorder, she had firsthand knowledge of the lack of services available to help parents suffering from mental health and substance abuse disorders and their at-risk children. She brought this service gap to the attention of the New York State Office of Mental Health and Department of Social Services, and then, in 1993, helped the office form a statewide Task Force on Mentally Ill Parents with Young Children. Task force recommendations led to the creation of the Invisible Children’s Program that same year. In 2001, SAMHSA recognized the program nationally, providing funding to evaluate and replicate it nationwide. Later that year, Mental Health America of Wisconsin received funding from the National Mental Health Association to replicate the initiative in Wisconsin. In 2011, the program transitioned to using the name Strong Families Healthy Homes to reflect the broader intent of the program.

Did It Work?

Back to Top

Results

Parent participants experienced reduced mental health–related stigma and stress, improved parenting skills and social support networks, and had relatively few psychiatric hospitalizations. Families were supported by providing children enhanced access to services for cognitive and/or developmental delays and through the facilitation of many lasting reunifications.
  • Improved parent health and skills: Parents participating in the program reported several improvements in health indicators related to their mental illness as well as factors that could help them become better parents.
    • Less stigma and stress: A survey taken at enrollment and every 6 months thereafter found that most participating parents reported a reduction in stigma associated with their mental health and in their overall level of stress.
    • Few hospitalizations: Data from a sample of 28 adults who participated for a year or more suggest the program led to relatively few psychiatric hospitalizations, with 64 percent having no such hospitalizations during the program (including 21 percent with a history of prior hospitalizations and 43 percent with no previous hospitalizations). In contrast, only 36 percent required hospitalization during the program; for approximately half, this was their first hospitalization and half had been hospitalized previously.
    • Improved parenting skills and support: The vast majority of families (87 percent) participating for at least a year reported improvements in parenting skills, while nearly half (49 percent) reported an improvement in their social support network.
  • Improved family health: Families benefited from the enhanced support of children's needs and many reunifications between parent and child(ren).
    • Enhanced access to services: All 135 children whose parents completed the organization's survey were connected to outside services to address cognitive and/or developmental delays; participants would have been highly unlikely to have access to such services in the absence of the program.
    • Many lasting reunifications: Since 2001, the program has served 53 families from child welfare services. Among those completing the program, 83 percent were reunified with their children, and all of these families have remained together since being reunited.

Evidence Rating (What is this?)

Moderate: The evidence consists of self-reported results from participating parents on levels of stigma and stress, parenting skills, and support networks. Surveys were completed at baseline (by 47 adults with 135 children) and after 6 months of participation (by 18 adults). Additional evidence consists of post-implementation data on connections to needed services for children, psychiatric-related hospitalizations while in the program, and reunifications among families temporarily losing custody of one or more children.

How They Did It

Back to Top

Planning and Development Process

Key steps in the planning and development process included the following:
  • Consulting with experts: The chief executive officer of Mental Health America of Wisconsin talked with her counterpart at Mental Health America of Orange County, NY, about how to start the program in Wisconsin. The organization then completed a thorough needs assessment of Milwaukee families.
  • Forming steering committee: Mental Health America of Wisconsin created a steering committee that included representatives from the Medical College of Wisconsin Department of Psychiatry, Children’s Service Society of Wisconsin, Children’s Hospital of Wisconsin, and community members dealing with co-occurring disorders. This committee assisted in designing the program structure and in referring the first clients to the program.
  • Developing partnerships with community organizations: In 2004, Mental Health America of Wisconsin started a partnership with the Milwaukee Child Welfare Bureau, offering the program on a fee-for-service basis to its child welfare clients. Additional partnerships later formed with homeless shelters, schools, and local family service providers. These partnerships proved essential to building a steady stream of client referrals.
  • Creating family resource center: Outside funding allowed Mental Health America of Wisconsin to create the Specialized Family Resource Center to offer special events, classes, and support groups related to recovery and parenting in 2005.
  • Training family advocates and peer mentors: The family advocates completed an orientation training including the history of the agency, agency requirements, safety, information on recovery and co-occurring disorders. These master's-level staff also participate in continuing education and an annual training on safety, abuse, reporting requirements and training. Peer mentors completed a 70-hour peer employment training course sponsored by Mental Health America of Wisconsin. This interactive competency based course included 16 learning modules that can be given as a 2-week, 3-week, or 5-week class. Topics covered included personal development, preparing for world of work, and skill development (communication, conflict resolution, recovery, and peer support). Successful graduates from the class became Certified Peer Support Specialists.

Resources Used and Skills Needed

  • Staffing: The Mental Health America of Wisconsin's Strong Families Healthy Homes program has 4.5 full-time equivalent (FTE) staff: two full-time, master’s-level family advocates; a full-time program manager; a part-time family advocate; and a full-time therapist (under contract).
  • Costs: The current annual program budget totals just below $300,000, with the bulk of funds used to cover salary and benefits for the 4.5 FTEs. Additional costs include those related to program events and services, including client transportation and childcare services. The per-family cost for program services averages roughly $1,000 a month.
begin fsxml

Funding Sources

Bureau of Milwaukee Child Welfare; United Way of Greater Milwaukee; Milwaukee County Behavioral Health Division; The Faye McBeath Foundation; Helen Bader Foundation, Inc.; Greater Milwaukee Foundation; Jane Bradley Petit Foundation; Zonta Foundation, Inc.; Child Abuse Prevention Fund; Northwestern Mutual Foundation; Elizabeth A. Brinn Foundation
Initial funding from the National Mental Health Association allowed Mental Health America of Wisconsin to create the Invisible Children's Program of Milwaukee in 2001 (now known as Strong Families Healthy Homes). Local foundation and county government funding allowed the program to grow. For example The Children's Trust Fund supported the development of the Specialized Family Resource Center, created in 2005. In 2004, Mental Health America of Wisconsin began offering the program on a fee-for-service basis to clients from the Bureau of Milwaukee Child Welfare. In 2009, Mental Health America of Wisconsin created a fee-for-service contract with a local family service provider for individual and family therapy services.end fs

Tools and Other Resources

The Web site for the Mental Health America of Wisconsin's Strong Families Healthy Homes can be found at: http://www.mhawisconsin.org/sfhh.aspx.

Mental Health America of Wisconsin's "Parenting Resources," an adjunct to Dr. Stephen Bavolek's curriculum, is available at: http://www.mhawisconsin.org/strengthening-families-resources.aspx.

META Peer Employment Training Program: http://www.recoveryinnovations.org/pdf/Peer%20Specialist%20Training%20FAQ.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Adoption Considerations

Back to Top

Getting Started with This Innovation

  • Determine program need: Complete an assessment of families in the local area to determine if a need exists for the program. The Mental Health America national office can assist in this process.
  • Consult with national program leaders: Talk with national and state program developers to obtain advice on how to start the program.
  • Develop partnerships: Create partnerships with state and local service providers as a way of building client referrals. Partnerships can be built with homeless shelters, schools, local family service providers, and state and local government agencies.
  • Seek diverse funding: Apply for funds from diverse organizations, including private community foundations and State and county government agencies.

Sustaining This Innovation

  • Ensure ongoing availability of peer mentors: Conduct periodic training sessions for peer mentors; typically at least a few mentors are needed at any point in time to run support groups and to monitor and support individual participants.
  • Maintain relations with referral sources: Regularly check in with existing and potential referral sources to remind them about the program and make sure that it continues to serve their needs.
  • Connect "graduating" families to ongoing sources of support: Families often need continued support after the program ends; local agencies often can provide ongoing services.

Use By Other Organizations

The following Mental Health America affiliates are in various stages of program implementation:
  • MHA of Charlottesville-Albemarle, Charlottesville, VA
  • MHA of Columbia-Greene Counties, Hudson, NY
  • MHA of Greater Knoxville, Knoxville, TN
  • MHA in Passaic County, Clifton, NJ
  • MHA of the Southern Tier, Binghamton, NY
  • MHA of Dutchess County, NY
  • MHA in Passaic County, Clifton, NJ
  • MHA of Sacramento, CA
  • MHA of Southeastern PA
  • MHA of Texas

More Information

Back to Top

Contact the Innovator

Martina Gollin-Graves
Project and Outreach Manager
Mental Health America of Wisconsin
Phone: (414) 336 -7972
Fax: (414) 276-3124
E-mail: martina@mhawisconsin.org

Innovator Disclosures

Ms. Gollin-Graves has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

The Strong Families Healthy Homes Web site can be accessed at: http://www.mhawisconsin.org/sfhh.aspx.

The Substance Abuse Mental Health Service Administration (SAMHSA) National Mental Health Information Center: Critical Issues for Parents with Mental Illness and their Families is available at: http://www.uwgb.edu/bhtp/tools/critical_issues.pdf.

Footnotes

1 Becker MA, Giard J, Chen R. Study of Women with Co-Occurring Disorders and Lifetime Histories of Interpersonal Trauma. Tampa, FL: University of South Florida, Louis De La Parte Florida Mental Health Institute; 2004. Available at: http://mhlp.fmhi.usf.edu/ahca/2004-Becker_co_disorders.cfm
2 O'Connell ME, Boat T, Warner KE. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: National Academies Press. Available at: http://www.nap.edu/catalog.php?record_id=12480
3 Mowbray CT, Oyserman D, Bybee D, et al. Life circumstances of mothers with serious mental illnesses. Psychiatr Rehabil J. 2001;25(2):114-23. [PubMed]
4 Park JM, Solomon P, Mandell DS. Involvement in the child welfare system among mothers with serious mental illness. Psychiatr Serv. 2006;57(4):493-7. [PubMed]
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: October 27, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 23, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: September 23, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.