Family SMILES Evidence, impact and evaluation

We’re evaluating the Family SMILES approach to working with the children of parents with mental health problems. We've 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. Recent 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 aims 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 is 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're evaluating this service

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

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

Impact evaluation

The impact evaluation is a quasi-experimental design. It uses the naturally occurring group of children and parents waiting for a group to commence as a comparison group. Parents and children only become part of the comparison group where there is not an appropriate group for them to start immediately and would be waiting, regardless of the evaluation, to receive the service.

Key primary outcomes of the service are measured using psychometric measures. Measures are 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

15 children and 16 parents who completed Family SMILES have been interviewed as part of the process evaluation. The interviews explored service users' experiences and helped to identify underlying facilitators and barriers to the programme bringing about change for parents and children.

8 NSPCC practitioners who deliver Family SMILES have also been interviewed. This has provided an insight into their perspectives on the outcomes that the programme achieves.

Referrers to the service will also be interviewed.

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 contained within the measure they were presented with.

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 Prakash Fernandes or Rachel Margolis.

What we've learnt so far

Our interim findings provide 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 interim evaluation.

What we're doing next

Further evaluation will provide more insight into whether these changes were sustained in the longer term, as well as findings from a comparison group who have not received the service. This will also include interviews with practitioners delivering the programme, and the agencies who referred families to the service.

Impact and evidence hub

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.