Family SMILES - Evidence, impact and evaluation At a glance

We evaluated the Family SMILES approach to working with the children of parents with mental health problems. We found promising evidence that it can help parents understand and reduce the impact of their mental health problems on their children.

How families' multiple and complex needs affect children

There is a growing emphasis on the need for more effective early intervention to help support families who have multiple and complex needs. Research (Devaney et al, 2013) suggests that the majority of serious child abuse cases involve families where parents are experiencing multiple challenges.

Experiencing social isolation, substance misuse, domestic abuse or mental health problems can make it harder for parents to deal with family life and put pressure on relationships. Those exposed to multiple adversities in childhood are at increased, cumulative risk of negative psychological, emotional and health-related outcomes in later life (Davidson et al, 2012).

Read more about child abuse and neglect.

How Family SMILES is helping protect children

Having a mental health problem doesn't necessarily mean that a mum, dad or carer will find it difficult to care safely for their child. However research does show that parental mental ill health is a fairly common element in child protection investigations. In a recent study of serious case reviews in London it was found that 60% of children subject to a review had a parent with mental health problems that affected child care (Prokop et al., 2010).

Negative effects of parental mental illness on children can include:

There is growing evidence that providing effective support for families with mental illness can help mitigate these effects.

Family SMILES aimed to:

  • improve children's self-esteem, resilience and life skills
  • help parents understand the impact of their mental health problem on their child
  • improve protective parenting skills.

Family SMILES was based on the Australian Simplifying Mental Illness plus Life Enhancement Skills (SMILES) programme, developed in 1997 by Erica Pitman (Pitman, 2010).

The Australian SMILES programme originally involved group work with young carers with a parent or sibling with a mental health problem. It has been used in other countries, including Canada, and positively evaluated in a number of reports (Pitman and Matthey, 2004; Baldwin and Glogovic, 2010).

How we evaluated this service

Using standardised measures and qualitative interviews we evaluated the effectiveness of Family SMILES to keep children safe from harm.

There were 2 components to the evaluation of Family SMILES - an impact evaluation and a process evaluation.

Impact evaluation

The impact evaluation was a quasi-experimental design. It used the naturally occurring group of children and parents who were on the waiting list for the service as a comparison group. Parents and children only became part of the comparison group where there was not an appropriate group for them to join immediately. They would be waiting to receive the service regardless of the evaluation.

We measured key primary outcomes of the service using psychometric measures. These were collected at 4 time points:

  • T0: at least 8 weeks before the programme begins
  • T1: just before starting the programme
  • T2: at the final session of the programme
  • T3: 6 months after leaving the programme.

Process evaluation

We interviewed children and parents who completed Family SMILES. The interviews explored their experiences and helped to identify what helped bring about change for parents and children, as well as any barriers.

We also interviewed NSPCC practitioners who delivered Family SMILES. This provided an insight into their perspectives on the outcomes that the programme achieves.

One of the biggest challenges in carrying out this evaluation was obtaining data from vulnerable parents with mental health problems. Parents using the programme often found it stressful to reflect on the questions we needed to ask for the evaluation.

In addition, some parents didn’t consent to completing the evaluation at the end of the work. This made it difficult to collect matched data at T1 and T2 from parents.

To overcome some of these challenges, practitioners built in extra time on sessions for parents to focus on the evaluations and explain the importance of the evaluation to parents.

This evaluation was carried out internally by the NSPCC evaluation department. It used the following measures:

  • Child Abuse Potential Inventory (CAPI) (protective parenting)
  • Adapted Rosenberg Self Esteem Scale for Children (child’s self-esteem)
  • Strengths and Difficulties Questionnaire (children’s emotional wellbeing)
  • HoNOSCA (Children’s social functioning)
  • Parent’s Evaluation Wheel (non- standardised) (parent understanding of impact of behaviour on child)
  • Children’s Evaluation Wheel (non-standardised) (children’s safety skills)

Find out more about the tools used to measure outcomes

For more information contact Rachel Margolis.

What we've learnt so far

Our final evaluation provided promising evidence that Family SMILES can help parents understand and reduce the impact of their mental health problems on their children. The Family SMILES service may be bridging a gap between adult mental health and children’s services by creating a safe space for parents and children to explore these issues.

Read the final evaluation.

What we're doing next

We're no longer running Family SMILES. But using what we learnt from our evaluation, we've worked with partners to modify the programme so it's suitable for long term delivery in the NHS. We're now in the process of evaluating the new service - Young SMILES.

Impact and evidence

Find out how we evaluate and research the impact we’re making in protecting children, get tips and tools for researchers and access resources.

Our impact and evidence

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  1. Aldridge, J. (2006) The experiences of children living with and caring for parents with mental illness in Child Abuse Review 15(2): 79-88. [Freely view abstract or access full text by subscription: Child Abuse Review 15(2): 79-88].

  2. Baldwin, P. and Glogovic, C. (2010) Providing S.M.I.L.E.S to children of the Waterloo region whose caregiver has a mental health diagnosis in Ontario Association of Children's Aid Societies Journal, 55(1).

  3. Davidson, G., Bunting, L. and Webb, M.A. (2012) Families experiencing multiple adversities: a review of the international literature (PDF). Belfast: Barnardo's Northern Ireland.

  4. Devaney, J., Bunting, L., Hayes, D. and Lazenbatt, A. (2013) Translating learning into action: an overview of learning arising from case management reviews in Northern Ireland 2003-2008. Belfast: Department of Health, Social Services and Public Safety (DHSSPS).

  5. Pitman, E. (2010) SMILES program: simplifying mental illness plus life enhancement skills. Adelaide S. Aust.: Children Of Parents with a Mental Illness (COPMI).

  6. Pitman, E. and Matthey, S. (2004) The SMILES program: a group program for children with mentally ill parents or siblings in American Journal of Orthopsychiatry 74(3): 383-388.

  7. Prokop, J., Bundred, K. and Green, J. ([2010]) Background paper on London serious case reviews completed April 2006 - September 2009 (PDF). [London]: London Safeguarding Children Board.

  8. Stallard, P. et al (2004) The effects of parental mental illness upon children: a descriptive study of the views of parents and children. Clinical Child Psychology and Psychiatry 9(1): 39-52.

  9. Tunnard, J. (2004) Parental mental health problems: key messages from research, policy and practice. Totnes, Devon: Research in Practice.