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Support groups for children of mentally ill or addicted parents

When a family member suffers from mental illness or addiction problems, the whole family is affected. Children and young people living in families with mental illness or addiction can get help to manage their situation through support groups. Through the support group, they can gain knowledge about the parent's condition and how it affects the family and an opportunity to meet others in a similar situation and share thoughts, feelings and experiences.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut201904 Registration no: SBU 2018/359

Question

What effect do support groups for children and adolescents living in families with mental illness or addiction have on the child's well-being, knowledge of the parent's condition, and school performance, in comparison with individual sessions or no treatment?

Table with identified studies

Table 1. Systematic reviews.
Included studies Population Outcome
Bröning et al. 2012 [1]
Selective prevention programs (6 school-based in peer-group format, 2 community-based in peer-group format, 5 family-based)

Based on: 7 randomized controlled studies, 2 controlled studies, 3 descriptive studies, 1 qualitative study		 Children (0 to 17 years old) from substance-affected families (a) Own reduction of substance consumption or abstinence
(b) Coping strategies
(c) Social behavior
(d) Self-worth
(e) Program-related knowledge
(f) Unexpected findings / negative effects
Authors' conclusion:
“All forms of intervention, i.e., school-based, community-based, and family-based interventions, showed valuable results, but these are found in a very small number of program evaluation studies. Thus, while there is evidence for programs’ effectiveness in reducing high-risk children’s problems and improving positive behaviors, coping skills, and feelings, it remains preliminary.”

 

Table 2. Controlled trials.
Population Intervention and control Outcome
Van Santvoort et al. 2014 [2]
254 Children (8 to 12 years old) with a parent meeting the DSM-IV diagnostic Axis I or Axis II criteria or ICD-10 criteria for a mental disorder or substance use disorder. Random allocation to:

I: Support groups for children, 8 weekly 90-min sessions and a booster session after 3 months.

C: Control group attended three group-based leisure activities		 (a) Child’s social support
(b) Child’s cognitions
(c) Child’s perceived competence
(d) Parent–child interaction
(e) Emotional and behavioural problems of the child
Authors' conclusion:
”In conclusion, this study showed that children of mentally ill and/or addicted parents benefit from preventive support groups, mostly on specific problems these children encounter, such as negative cognitions, low social support and feelings of social exclusion. The study did not find evidence for support groups as being an effective instrument for the reduction of emotional and behavioural problems in these children. Until the support groups are further improved and/or research has contradicted the present outcomes, we believe expectations about the support groups should be adjusted: they are effective for direct worries and problems these children encounter, but more intervention into their complex family lives is required when emotional and behavioural problems need to be diminished.”
Fraser et al. 2008 [3]
44 children with a parent with a mental illness (12-18 years old) No random allocation.

I: Peer support intervention in three 6 h group sessions (n = 27)

C: Wait-list control (n = 17)		 (a) intervention targets (mental health literacy, connectedness, coping strategies)
(b) adjustment (depression, life satisfaction, prosocial behaviour, emotional/behavioural difficulties)
(c) caregiving experiences
Authors' conclusion:
“Given study limitations and the modest support for intervention effectiveness it is important that this and other similar interventions should continue to be revised and undergo rigorous evaluation.”
Roosa et al. 1989 [4]
81 children (9 to 13 years old) concerned about parental drinking. Random allocation to:

I: Preventive intervention program (SMAAP; groups of 8 to 10 children once a week) with brief lectures, group discussions, role playing, and home-work assignments for 8 weeks (n = 25).

C: Control group (n = 55)		 (a) global self-concept and selfevaluations
(b) coping behaviors
(c) Children's Depression lnventory
(d) Behavior Rating Scale questionnaire on opinions on the program
Authors' conclusion:
”The results of this pilot study should be encouraging to all who are interested in providing services to children of alcoholics. First and most importantly, it has been demonstrated that one can gain access to the difficult-to-locate population of young children of problem drinking parents and that these children are interested in seeking help. Further, the recruitment strategy used was apparently nonthreatening to alcoholic families based on the rate at which children received parental permission to participate. Finally, young children who show concern about parental drinking can be taught to use positive coping strategies. Although the efficacy of the SMAAP intervention awaits further evaluation, the results of the pilot study suggest that the basic foundation for a successful preventive intervention for COAs has been identified. That is, these children can be recruited at an age that makes prevention a realistic possibility, they are receptive and responsive to intervention efforts, and they can learn to use positive coping strategies to deal with stressful events in their lives.”

 

Table 3. Qualitative studies.
Population Intervention and control Outcome
Isobel et al. 2017 [5]
12 children and young people (9 to 17 years old) who have a parent with a mental illness I: Biannual 2-day child focused program that includes a mixture of fun, psycho-education and strengths-based activities aimed at fostering resilience

C: No control group		 Interpretative hermeneutic phenomenological approach, using semi-structured interviews and focus groups and thematic analysis with the purpose of investigating the meaning and experience of participation in the program
Authors' conclusion:
”The school holiday program is a unique component of this adult mental health service that allowed for flexible and longitudinal engagement, early intervention and prevention with children and families where a parent has a mental illness. This program demonstrated an important philosophical commitment to family-focused practice. Children and parents benefited from being connected and supported without feeling stigmatised by the mental health early intervention role of the staff. The connection formed between staff and children was of mutual benefit and provided a much needed pathway of access to a group of children and young people who otherwise may be lost to services.”
Woolderink et al. 2015 [6]
13 youth who have an addicted or mentally ill parent and 4 providers of the intervention I: Online 8-week group course with supervision by 2 trained psychologists or social workers (Kopstoring).

C: No control group		 Process evaluation using inductive qualitative content analysis with the purpose of investigating expectations, experiences, and perspectives of participants and providers of the online Kopstoring course
Authors' conclusion:
“Five main themes emerged from these interviews: background, the requirements for the intervention, experience with the intervention, technical aspects, and research aspects. Overall, participants and providers found the intervention to be valuable because it was online; therefore, protecting their anonymity was considered a key component. Most barriers existed in the technical sphere.”
Wolpert et al. 2015 [7]
6 young people (4–16 years old) who have parents with mental illnesses and 5 parents attending the groups, and 9 former service users I: Monthly psycho-educational workshop (discussions about the meaning of mental health, dramatizations), and concurrent parents’ groups, as well as joint seminars and review sessions (Kidstime programme)

C: No control group		 Thematic network analysis with the purpose of investigating the Kidstime workshop experience
Authors' conclusion:
“Five themes emerged from the thematic analysis: initial engagement, sharing with others, learning about mental health, opportunity for fun and impact on family relationships. Areas for further development were identified including the formation of a distinct adolescent Kidstime workshop to better meet their age-specific needs, and adjustments to the system for introducing new families to established workshop groups. Given the positive experience of the groups by those attending, a rigorous evaluation of the approach is suggested.”
Nilsson et al. 2015 [8]
7 young women (between 18 and 26 years old) who have parents with mental illnesses and a childhood experience of support groups. I: Completed participation in a support group

C: No control group		 Qualitative manifest content analysis with the purpose of investigating young adults’ childhood experiences of support groups
Authors' conclusion:
“This study highlights the need for support groups for children who have parents with a mental illness. It also highlights the importance of listening to children’s stories, even if the stories are untold and kept secret by the children, and to act on them. The findings of this study show that these young adults felt that they were let down by the adult world during their childhood and that this had led to difficulties trusting other people, although participation in the support group seems to have made it somewhat easier for these young adults to seek help later in their lives.”
Templeton 2014 [9]
37 children with parents with substance misuse and 36 parents that attended the programme I: Structured educational and psychosocial programme for families affected by parental substance misuse for eight consecutive weeks, combining separate work with children and adults with work with family units or the whole group together (Moving Parents and Children Together programme: M-PACT)

C: No control group		 Thematic realist analysis with the purpose of evaluating the M-PACT programme
Authors' conclusion:
“Six themes are discussed: engaging with M-PACT, shared experiences, understanding addiction, changes in communication, healthier and united families, and ending M-PACT. The majority of families benefitted in a range of ways from the programme: meeting others who were experiencing similar problems, greater understanding about addiction and its impact on children and families improving communication within the family. In many families there was more openness and honesty, stronger relationships and more time as families, and a reduction in arguments and conflict.”
Foster et al. 2014 [10]
14 children/adolescents (9–17 years old) who have parents with mental illnesses I: Peer support programme (ON FIRE) with core program activities including fun days and camps. The program is not time limited.

C: No control group		 Exploratory qualitative design with semi-structured interviews with the purpose of investigating how the programme was experienced
Authors' conclusion:
“Participants in this study derived substantial personal benefit from participating in ON FIRE. Connections with peers fostered resilience and helped alleviate feelings of stigma, isolation, and loneliness. Participants reported pursuing new friendships with other ON FIRE members which they valued. They spoke about the opportunities provided by the program to develop their strengths and capabilities, and how program activities enabled them to face their fears, find personal courage, and develop abilities and achieve tasks that they had not achieved before. Activities enabled them to learn cooperation with each other and what it means to help other people. These findings indicate that young people’s abilities and perspectives of themselves and their situations have potential to be transformed by participating in peer support and to build resilience. The addition of family fun days and support for parenting could strengthen relationships between the family members.”
Gance-Cleveland 2004 [11]
Adolescents with an addicted parent.

21 participant observations, 13 interviews, 8 written evaluations		 I: School-based support groups

C: No control group		 Qualitative evaluation using the ethnographic method to investigate the features, critical attributes, processes, and benefits of school-based support groups
Authors' conclusion:
“Findings from this study suggest that school-based support groups are beneficial lo adolescents with addicted parents. Experiential knowledge is the foundation of these self-help groups. School-based support group participation enhanced self-knowledge and led lo self-care and self-healing. The school-based support groups expanded the adolescents' awareness, resulting in their ability to make critical choices that facilitated changes in the dysfunctional pattern. Support group participation empowered youth lo make these changes.”

 

References

  1. Bröning S, Kumpfer K, Kruse K, Sack PM, Schaunig-Busch I, Ruths S, et al. Selective prevention programs for children from substance-affected families: a comprehensive systematic review. Subst Abuse Treat Prev Policy 2012;7.2.
  2. Van Santvoort F, Hosman CMH, Van Doesum KTM, Janssens JMAM. Effectiveness of preventive support groups for children of mentally ill or addicted parents: A randomized controlled trial. Eur Child Adolesc Psychiatry 2014;23:473-84.
  3. Fraser E, Pakenham KI. Evaluation of a resilience-based intervention for children of parents with mental illness. Aust N Z J Psychiatry 2008;42:1041-50.
  4. Roosa MW, Genshelmer LK, Short JL, Ayers TS, Shell R. A Preventative intervention for children in alcoholic families: Results of a pilot study. Fam Relat 1989;38:295-300.
  5. Isobel S, Pretty D, Meehan F. ‘They are the children of our clients, they are our responsibility’: A phenomenological evaluation of a school holiday program for children of adult clients of a mental health service. Advances in Mental Health 2017;15:132-146.
  6. Woolderink M, Bindels JA, Evers SM, Paulus AT, van Asselt AD, van Schayck OC. An online health prevention intervention for youth with addicted or mentally ill parents: Experiences and perspectives of participants and providers from a randomized controlled trial. J Med Internet Res 2015;17:e274.
  7. Wolpert M, Hoffman J, Martin A, Fagin L, Cooklin A. An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: Parents' and young people's views. Clin Child Psychol Psychiatry 2015;20:406-18.
  8. Nilsson S, Gustafsson L, Nolbris MJ. Young adults' childhood experiences of support when living with a parent with a mental illness. J Child Health Care 2015;19:444-53.
  9. Templeton L. Supporting families living with parental substance misuse: the M-PACT (Moving Parents and Children Together) programme. Child Fam Soc Work 2014;19:76-88.
  10. Foster K, Lewis P, McCloughen A. Experiences of peer support for children and adolescents whose parents and siblings have mental illness. J Child Adolesc Psychiatr Nurs 2014;27:61-7.
  11. Gance-Cleveland B. Qualitative evaluation of a school-based support group for adolescents with an addicted parent. Nurs Res 2004;53:379-86.

Literature search

Literature search.pdf

Project group

Nathalie Peira, Maja Kärrman Fredriksson, Sara Fundell and Miriam Entesarian Matsson at SBU.

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