Final evaluation of Family SMILES Improving wellbeing for children with parents with mental health problems

Two girls laughing and playing in a gardenFamily SMILES supports children and families where parents have mental health problems. It aims to help parents understand how their mental health could affect their child, develop new parenting skills and improve children's wellbeing and behaviour.

We evaluated the service to find out what impact it has on children and families. We asked children, parents and practitioners what improvements they had seen as a result of the programme, what they found particularly helpful and what challenges they experienced. This report is part of our Impact and evidence series.

Authors: Rachel Margolis and Prakash Fernandes
Published: 2017

Our evaluation is based on the experiences of 59 parents and 230 children who took part in Family SMILES between September 2011 and December 2015.

Changes experienced by children and parents who took part in Family SMILES

  • There was a small but statistically significant improvement in children's emotional wellbeing and behaviour. They reported feeling:
    • more confident
    • more able to engage in a range of new and different activities
    • more able to express their feelings to trusted adults
    • less anxious and more reassured.
  • There were improvements in parents' abilities to communicate with their children and positive changes in their parenting.
  • Parents reported a significant improvement in their children's emotional wellbeing. However, children did not report a significant improvement in this area. This could be because parents and children perceive changes differently or the changes parents observed were not matched by their children's own experience.
  • Our data suggested continuing improvements in children's behaviour and self-esteem 6 months after completing Family SMILES. However, these changes were not statistically significant. This means we can't state conclusively that changes were sustained beyond the end of the programme.

What children and families found helpful

  • Children valued meeting others facing similar difficulties and learning about mental health. Group work helped them to understand they weren't to blame for their parents' mental health problems.
  • Parents appreciated being able to reflect on the impact of challenges they had experienced in their lives. They also found the programme's strengths-based approach helpful as this enabled them to recognise their positive qualities as a parent.
  • Families found the programme gave them the language to talk about mental health with each other. Children suggested that having a better understanding of their parent's mental health problem also helped them to respond confidently and appropriately when their parents were experiencing difficulties.
  • Families found the structure of Family SMILES helpful. It gave them space to work individually, in peer groups or together as a family. This highlights the value of an approach that works with the whole family, bringing together adults and children in one setting instead of them working with different agencies.

We've worked with partners to modify Family SMILES so it's suitable for long-term delivery in the NHS. We've also developed Young SMILES, a new service which supports children whose parents have mental health illnesses.

Acknowledgements 5
Executive summary 6
Chapter 1: Introduction 11
Chapter 2: Outcomes for children and young people 29
Chapter 3: Outcomes for parents 50
Chapter 4: Exploring sustained change 66
Chapter 5: Conclusion and discussion 71
Bibliography 78
Appendices 81

"We were told that the mental illnesses and our parents getting ill wasn't our fault ... So, it was reassuring because I thought many times when mum used to go into hospital, I thought it was my fault; but it wasn't."

"It's been really important to me that no matter how kind of unwell I've been, that they don't have to stop being children, and that they don't take on too much responsibility."

"It gave me a chance to get everything out of my mind so I could actually say it to someone, so someone else knew what I felt."

Please cite as: Margolis, R. and Fernandes, P. (2017) Building children's confidence and improving parents' protective skills: final evaluation of the NSPCC Family SMILES service. London: NSPCC.

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