Young SMILES Evidence, impact and evaluation

Young SMILES builds on our successful Family SMILES service. We're working with partners to modify the service so it's suitable for long term delivery in the NHS.

It supports children aged 6 to 16 whose parents have mental health illnesses such as:

  • schizophrenia or psychosis
  • bipolar affective disorder
  • severe depression
  • personality disorder.

By working in group sessions with other children, as well as taking part in sessions with their own parents, we aim to help children who live with parental mental illness cope better with the challenges they face.

The University of Manchester is leading a team which is testing the service to find out if it is helpful for children and young people, and whether it provides additional benefits to the support that is currently on offer to them.

How parental mental illnesses can affect children

Parents or carers with mental health problems don't necessarily have difficulties providing a safe home environment for their child.

But children whose parents have a mental illness are at increased risk of having:

  • poorer mental and physical health
  • behavioural, social and educational difficulties
  • experiencing maltreatment and neglect
  • misusing alcohol or other substances. 

Some of these effects can extend into adulthood (Diggins, 2011, Stanley, 2003).

It can be difficult for children of parents with mental illness to get the help they need. They may not know that they are entitled to support. If they do know, they may have concerns about the stigma of mental health problems, or worry about getting their parents into trouble if they ask for help.

Once they do decide to speak out, it can be difficult to know who to ask. Child and adolescent mental health services (CAMHS), NHS adult mental health services, social care and child protection services are often located in different places and are managed separately.

This mean that children can 'fall through the gaps' between different health and social care providers.

How we're evaluating this service

A research team from the University of Manchester is leading and managing the evaluation of Young SMILES. They will work closely with all of the other people and organisations working on the study and delivering the intervention.

This includes other researchers and delivery teams working at different Universities, clinicians in Northumberland Tyne & Wear NHS Foundation Trust, people working for the NSPCC services in England and Barnardo's in Newcastle. The evaluation is funded by a grant from the National Institute for Health Research.

The research team led by the University of Manchester will evaluate the feasibility of Young SMILES by carrying out a randomised control trial (RCT) with 60 families.

15 of these families will access the Young SMILES service delivered by NSPCC and 15 will continue to receive their usual care. Another 15 will access the Young SMILES service delivered by NHS in Northumberland and a further 15 will continue to receive usual care.

The children and young people taking part in the RCT will be asked to complete questionnaires 4 times - at the start of the study, and again after 3, 6 and 12 months. This will enable us to see how they rate their quality of life at different times during the programme and work out whether Young SMILES helped to make any improvements.

The research team is using the following tools to evaluate the service:

  • Adult Service Use Schedule (Ad-SUS) – modified version
  • Arnold-O'Leary parenting scale
  • Case vignettes with follow-up questions
  • CHU-9D
  • KIDSCREEN
  • Parenting Stress Index Short Form
  • PEDQOL
  • Revised Child Anxiety and Depression Scale
  • Strengths and Difficulties Questionnaire

We've used what we've learnt from the Family SMILES programme to help develop Young SMILES, make sure it can be delivered by the NHS, and tailor it to meet the needs of children whose parents have serious mental health problems.

What we're doing next

The findings of this study will help us decide if we need to make any changes to the way Young SMILES is delivered.

If the pilot is successful, The University of Manchester will lead a team to test the service on a larger scale. This will find out how effective it is in supporting vulnerable families, and what the outcomes are for children.

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References

  1. Diggins M (2011) Think child, think parent, think family: a guide to parental mental health and child welfare. Social Care Institute for Excellence: London.

  2. Stanley N et al (2003) Working on the interface: identifying professional responses to families with mental health and child-care needs. Health & Social Care in the Community, 11 (3): 208–218.