Psychiatric Rehabilitation Journal Copyright 2009 Trustees of Boston University

2009, Volume 33, No. 2, 133–141 DOI: 10.2975/33.2.2009.133.141

Article

Early Outcomes of a Pilot

Psychoeducation Group
Intervention for Children of a
Parent with a Psychiatric Illness
▼

Joanne Riebschleger, Betty Tableman,

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Danielle Rudder, Esther Onaga

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Michigan State University
Peg Whalen
Alliance for Children & Families,
Milwaukee, WI
Acknowledgements: The authors thank the
Families and Communities Together (FACT)
Coalition of Michigan State University for
funding this pilot study.
Objective: This study reports early findings of a still-developing Youth Education
and Support (YES) pilot intervention of multifamily group psychoeducation for
youth with a parent with a psychiatric illness. Methods: Hypotheses predicted YES
participants would increase pre-to-post: 1) Knowledge of psychiatric illness and
recovery, and 2) Coping. A purposive sample of 17 youth, ages 10-16, participated
in six lively, activity-focused, two-hour sessions within four groups facilitated by
the PI and professionals employed within two public mental health agencies. Data
revealed a significant increase in pre-to-post youth-reported knowledge (p= less
than .001) and no significant change in overall coping. At post-intervention, youth
reported significantly increased use of the coping skills of avoiding problems and
relaxing, as indicated within these coping subscales. Conclusions: Study limita-
tions merit interpretation caution. They are useful for future research, including
development and testing of youth psychoeducation programs with longer inter-
ventions, more emphases on coping, parent-inclusion, and larger samples using
randomized, experimental designs. Suggestions for research, practice, and policy
are provided.

Keywords: mental health education, youth perspectives, resiliency, and family

issues

Introduction and Background

This analysis reports early outcomes
of a pilot psychoeducation interven-
tion for middle school youth of a par-
ent with a psychiatric illness, i.e.,
depression, anxiety, schizophrenia,
and/or personality disorder (APA,
2004). These youth have greater ge-
netic risk for acquiring a psychiatric
illness (Henin, et al., 2005; Smith,
Muir, & Blackwood, 2003). Family
members often share an environment
with multiple, accumulative stressors,
e.g., poverty, unemployment, poor
housing, divorce/separation, isola-
tion, stigma experiences, disruption
of child-parent bonds, domestic vio-
lence, and insufficient re-
sources/supports (Beardslee, 2002;
Cowling, 1999; Hinden, Biebel,
Nicholson, & Mehnert, 2002;
Maybery, Reupert, Patrick, Goodyear,
& Crase, 2005b; Riebschleger, 2004).
Stressors can be heightened by the
cyclical intensity of psychiatric illness-
es and socioeconomic discrimination.
A highly stressful environment may
lead to, or elevate, youth psychiatric
symptoms, making it more likely that

133
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Early Outcomes of a Pilot Psychoeducation Group Intervention for Children

Fig u re 1 — Conc ep t u a l Fl ow of Y ou t h Ps yc hoedu c a t ion Res ea rc h in communication about psychiatric ill-

Figure 1—Conceptual Flow of Youth Psychoeducation Research
ness within the family; 6) maintaining
Theory Application Assumptions Intervention a Measures
Theory Application Assumptions Intervention a Measures strong sibling bonds; 7) talking to
friends; 8) connecting with nurturing,
Stress, Child Peer & adult Multi-family group A-COPE e positive adults; 9) receiving support
coping, & experiences support, info b intervention: for measures child
adaptation multiple facilitates child of a parent coping skills, from extended family/others; 10) hav-
theory stressors child coping with PI c e.g., optimism,
ing a parent involved in one’s educa-
social support,
! ! ! Six sessions: relaxing, & tion; 11) being involved in
1. Info about PI: solving or
Prevalence avoiding
community/school activities; 12) devel-
Resiliency Strong coping Child develops 2. PI: problems oping/building on special talents; and
Theory & protective resiliency via Causes
factors yield info b, coping, 3. MH Tx d
13) having an easy-going temperament
KPIRT f
resiliency. support, talents 4. PI Stigma (AACAP, 2004; Beardslee & Gladstone,
! 5. Coping
measures child
! ! knowledge of 2000; Beardslee, Wright, Gladstone, &
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

6. Hope: For PI & MH Tx,

This document is copyrighted by the American Psychological Association or one of its allied publishers.

recovery & i.e., Forbes, 2007; Handley, Farrell,

functioning prevalence,
Evidence- Multi-family Josephs, Hanke, & Hazelton, 2001;
causes,
based family group All sessions: Maybery, Ling, Szakacs, & Reupert,
treatment,
Interventions psycho- Discussion & stigma, 2005a; Östman & Hansson, 2002;
+ Needs Lit. g education: activities coping, &
child, adult Pölkki, Ervast, & Huupponen, 2004;
! ! hope
Sherman & Sherman, 2006). Twelve of
these factors can serve as targets for
aa Intended
Intended to prevent,
to prevent, delay,
delay, and/or and/or
ameliorate ameliorate
child child psychiatric
psychiatric symptoms. symptoms.
Includes primary Includes
and secondary
prevention.
strengthening within developing pro-
primary and secondary prevention.
b
b Info = Information grams for youth with a parent with a
c Info = Information
PI = Psychiatric illness
psychiatric illness. They are catego-
cd MH
PI Tx= =Psychiatric
Mental health treatment
illness
e
Adolescent Coping Orientation to Problem Experiences (A-COPE; Patterson & McCubbin, 1987). rized as: a) information sharing (1);
df Knowledge
MH Tx =ofMental health
Psychiatric treatment
Illness and Recovery Test (KPIRT): Author name/s to be added after peer review, 2006. b) coping skills (2, 3, 4); c) social sup-
g
Lit = Literature; Needs literature includes assessment of the needs of children with a parent with a mental illness.
eThis
Adolescent Coping
includes reported needsOrientation to Problem
for information and coping. Experiences (A-COPE; Patterson & port and communication (5, 6, 7, 8);
McCubbin, 1987). and d) building educational and other
f Knowledge of Psychiatric Illness and Recovery Test (KPIRT): Author name/s to be competencies (10, 11, 12).
added after peer review, 2006.
Psychoeducation
g Lit = Literature; Needs literature includes assessment of the needs of children with a
parent with a mental illness. This includes reported needs for information and coping. With the exception of the latter, these
targets are consistent with two
decades of family psychoeducation
the youth will enter adulthood with a conceptual model underlying the inter- programs that involve family members,
psychiatric illness (Cannon, et al., vention. clinicians, and adults or children with a
2008). The psychoeducation program psychiatric illness (Eskandanri, Karami,
Youth facing many stressors may bene- Sharifi, & Taheri, 2007; Hogarty,
described herein is a beginning inter-
fit from coping skills (Clarke, 2006; Anderson, & Reiss, 1990). Main curricu-
vention that may help youth to avoid
Smith & Carlson, 1997). When youth lum emphases included information,
or delay the onset of a psychiatric ill-
engage in effective coping skills, they coping, communication, and social
ness (primary prevention). For youth
are more likely to develop protective support. Family psychoeducation for
with psychiatric symptoms, the inter-
factors associated with youth who are adults is becoming a mainstream evi-
vention may disrupt the symptom es-
resilient and healthy (Van Breda, dence-based program per demonstrat-
calation process (secondary
2001). Youth resiliency-related protec- ed improvements in consumer
prevention).
tive factors include: 1) accessing con- functioning and caregiver stress reduc-
Youth Coping and Resiliency crete information/education about tion (Dixon, et al., 2001). Gearing
More research is needed to understand parental psychiatric illness; 2) learning (2008) reviewed evidence-based psy-
the interactions among influences of problem-solving and coping skills; 3) choeducation interventions for children
youth psychopathology (Leverton, identifying feelings and regulating with a psychiatric illness. Gearing
2003; Peisah, Brodaty, Luscombe, & one’s affect; 4) having a positive, (2008) found evidence of positive out-
Anstey, 2002). Figure 1 illustrates the hopeful view of the future; 5) engaging comes from psychoeducation programs

article

134

for children with a psychiatric illness.
They included: 1) increased social sup-
port (Fristad, Goldberg-Arnold, &
Gavazzi, 2003), 2) increased service
utilization (Fristad et al., 2003; Pollio,
McClendon, North, Reid, & Jonson-
Reid, M, 2005), 3) improved youth be-
haviors (Ruffolo, Kuhn, & Evans, 2005;
Miklowitz et al., 2000), 4) lower psychi-
atric rehabilitation attrition (Pollio, et
al, 2005), and 5) reduced youth depres-
sion and mania (Miklowitz, et al.,
2000).
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Beardslee et al. (2007) piloted a pro-
gram for children whose mothers had
depression. Professionals helped pre-
pare mothers and other family mem-
bers for a “family meeting” to discuss
the maternal psychiatric illness.
Outcomes included improved child,
parent, and family functioning. Riley et
al. (2008) developed a youth and par-
ent psychoeducation program.
Outcomes included improved youth
functioning, parent mental health, fam-
ily togetherness, and family involve-
ment for mealtimes and chores.
Children demonstrated decreased at-
risk clinical status from 62% pre-inter-
vention to 38% post-intervention.
Youth Education and Support (YES)
The still-developing YES psychoeduca-
tion program appears to be one of the
first multi-family group youth psychoe-
ducation programs to be developed
and tested. It was formulated from
main constructs of adult psychoeduca-
tion, including information and coping.
The YES program content also added
new youth-focused materials. Per evi-
dence from adult psychoeducation pro-
grams, the program used a
multi-family youth group approach. The
program targeted middle school chil-
dren. Early adolescence is a time of de-
velopmental risks for youth as they
negotiate increased academic expecta-
tions and peer pressures, while under-
going physical maturation (Hampel,
Meier, & Kümmel, 2008). Given issues
of practicality and resources, the first
phase of the intervention pilot targeted
only youth. Family member participa-
tion was deferred to the next phase of
model development.
The YES Psychoeducation Curriculum
was developed by the primary investi-
gator (PI) with a lively, activity-focused
format to fit the developmental needs
of adolescents, and as per youth sug-
gestions (Lenz, 2005, Riebschleger,
2004). The intent was to strengthen
youth protective factors, including in-
creased access to information about
parental psychiatric illness and in-
creased coping skills. Trained public
mental health professionals referred
youth to YES after obtaining parental
consent and youth assent for participa-
tion. The professionals provided demo-
graphic data; this included parents’
psychiatric diagnoses, and as applica-
ble, youth psychiatric diagnoses.
Two to three professionals facilitated
each group (facilitator n = 5). Four had
master’s degrees and all had five-plus
years of professional experience with
children and families. Agency facilita-
tors and the PI discussed in advance
how to implement the psychoeducation
group. This led to a draft manual writ-
ten by the PI, with modifications per
youth suggestions during the pilot. The
content explicated instructions, ses-
sion objectives, the sequence of activi-
ties, and written materials to
implement the curriculum similarly
across groups in order to promote fi-
delity. Six (two-hour) group sessions
were held in a community setting; each
included a themed discussion, a craft
activity, and a small attendance incen-
tive, e.g., inexpensive toys/gadgets,
school supplies, and chain restaurant
coupons. Most included a physical
group activity, e.g., a nature versus
nurture tug-of-war and “Simon Says.”
Each session began with a snack and
article
135
fa l l 2 0 0 9 — V ol u m e 3 3 N u m b e r 2
the “word of the day” that guided the
content of the session. They were: 1)
learning, 2) illness (psychiatric), 3) ef-
fective (rehabilitation), 4) stigma, 5)
coping, and 6) hope. Each session
ended with youth receipt of an incen-
tive and a take-home handout.
Session one focused on getting ac-
quainted, group rules, and purposes of
the group. Participants completed a
“feelings” craft activity tied to youth
protective factors of identifying feel-
ings. Session two was guided by the
correct answers to the knowledge scale
questions about prevalence. Youth cus-
tomized t-shirts with a fabric paint
handprint to delineate “one in five.”
They discussed psychiatric illnesses
and famous people with psychiatric ill-
nesses. They engaged in a physical
tug-of-war to represent “nurture” ver-
sus “nature” debates about causes of
psychiatric illnesses. The tug-of-war
aligned with youth protective factors of
team “problem-solving” and to no
small extent, “regulating one’s affect.”
Session three focused on the effective-
ness of psychiatric rehabilitation/
recovery. The youth created a decora-
tive mobile of recovery components,
e.g., medication, exercise, sunlight,
positive thinking, and having friends.
Session four focused on stigma. Youth
generated a list of negative terms de-
scribing people with psychiatric ill-
nesses. They shared stories of how
people with a psychiatric disability can
be treated. They viewed advertise-
ments showing how people with a psy-
chiatric disability are incorrectly
presumed to look physically strange
and/or to be more violent than people
without a psychiatric illness. They
played “Simon Says” in two-person
teams, advancing with correct answers
to the knowledge scale. Session five
addressed coping. Youth identified
their coping strategies by drawing a
“shield” of coping. Youth were asked
to identify activities that they are
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Early Outcomes of a Pilot Psychoeducation Group Intervention for Children

“good at” or that help them to feel bet-
ter when stressed. They prepared indi-
vidual crisis plans with steps to follow
and people to contact. They watched a
video about a child separated from his
mother due to her psychiatric crisis;
each child took notes and presented
discussion about feelings and coping.
This aligned with the protective factors
of identifying feelings, problem-solving,
talking with peers, and building/
developing special talents. Session six
focused on hope for achieving youth
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
dren’s services units of two public
mental health agencies, along with
child consumers’ middle school sib-
lings. The referred children had a par-
ent with a psychiatric illness.
Data were collected at the beginning of
group one (pre-intervention) and at the
end of the group six (post-intervention).
Youth completed the Knowledge of
Psychiatric Illness and Recovery Test
(KPIRT) (Riebschleger, 2006) to assess
their knowledge of psychiatric illness
support, investing in close friends,
seeking professional support, engag-
ing in demanding activity, being hu-
morous, and relaxing. Corcoran and
Fischer (2000) stated that the A-COPE
has fair to good internal consistency.
The reliability data from the Young
Adult-COPE, which is only slightly mod-
ified from A-COPE, showed an overall
Cronbach’s alpha of .82, with good sta-
bility per a test-retest correlation of
.83. They reported A-COPE has a fair
predictive validity for youth using sub-

and rehabilitation/recovery. The

This document is copyrighted by the American Psychological Association or one of its allied publishers.

goals and for effective recovery for stances.

people with psychiatric illness. Youth
discussed their future goals and meth-
ods to achieve those goals. They
played an interactive “pot of gold” ac-
tivity intended to help them develop
the resiliency protective factor of a pos-
itive, hopeful view of the future. Finally,
they decorated a “goodbye” cake with
symbols of what they learned in the
group.
Methods
Hypothesis one is: Youth participating
in the YES program will report signifi-
cant increase of knowledge of psychi-
atric illness and recovery from
pre-to-post intervention. Hypothesis
two is: Youth participating in the YES
program will report significant increase
of coping from pre-to-post interven-
tion.
Many attempts to access children of a
parent with a psychiatric illness
through the adult services systems of
numerous public mental health sys-
tems revealed that no site was able to
identify enough children of adult con-
sumers to conduct one group of 6-10
middle school youth. The investigators
were repeatedly told that mental health
consumers did not have children, had
lost their children, or there was no way
to identify and/or locate the children.
Sampling was then drawn from a pur-
posive sample of consumers of chil-
instrument contains 27 true/false and
multiple-choice questions items center-
ing on the prevalence of psychiatric Results
illness, causes of psychiatric illness,
Seventeen of 21 children completed the
functioning of people with psychiatric
YES program. One youth dropped after
illness, stigma, and psychiatric rehabil-
session one, two moved away, and one
itation. The PI used or modified ques-
decided to use the group time to be
tions from instruments from advocacy
with friends. Agency A conducted
programs and the literature, i.e., the
group 1 (n = 5) and 3 (n = 3). Agency B
Alaska Mental Health Board, 2004
conducted group 2 (n = 5) and group 4
(question n = 8); Sherman & Sherman,
(n = 4). Chi square analyses showed no
2006, p. 13 (n = 6); and the Centre for
significant differences by groups for
Addiction and Mental Health, 2001 (n =
gender, age, ethnicity, or the number
2). The PI wrote 11 new questions. The
of siblings. The data were combined
word processing program Flesch-
into one unit for purposes of analyses.
Kincaid instrument identified the items
on the KPIRT as early 5th grade reading Participants included 16 Caucasians
level. Prior to group one, the instru- and one African-American, aged 11–16.
ment was pre-tested with six middle The mean age was 13.06 years (SD =
school children. Since most scale items 1.39). Seven participants were siblings.
came from instruments developed by The majority of participants were male
mental health advocacy organizations (n = 13) and receiving mental health
and the practice literature, the new services (n = 13). Fourteen youth had
scale appears to have good face validi- one or more concurrent diagnoses, in-
ty and may yield results similar to cluding ADHD (n =12), unspecified
those of the source instruments. mood disorders (n = 3), oppositional
defiant disorders (n = 3), depressive
To measure coping skills, youth com-
disorders (n = 2), bipolar disorder (n =
pleted a 54-item standardized instru-
1), pervasive developmental disorder (n
ment called the Adolescent Coping
=1), post-traumatic stress disorder (n =
Orientation to Problem Experiences (A-
1), intermittent explosive disorder (n =
COPE, Patterson & McCubbin, 1987).
1), and learning disability (n = 1).
Coping subscales were ventilating feel-
Specific services data were not collect-
ings, seeking diversions, developing
ed but referring professionals worked
self-reliance/optimism, developing so-
with some YES participants in public
cial support, solving family problems,
mental health programs of
avoiding problems, seeking spiritual

article

136

Wraparound, child therapy, and servic-
es coordination programs.
The youth came from 13 families. All
but two of the youth lived in the home
of a parent in recovery. Single parents
or single grandparents headed 11 of
the families. Of the 15 custodial and
non-custodial parents with psychiatric
illness, nine had more than one diag-
nosis. Most were recovering from mood
disorders, including bipolar disorder (n
= 6), depressive disorder (n = 5), dys-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
thymic disorder (n = 2), unspecified de-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
pressive disorder (n = 2),
schizoaffective disorder (n = 1), or anxi-
ety (n = 1). Current or previous sub-
stance abuse was noted for seven
parents. Other diagnoses included bor-
derline personality disorder (n = 3), un-
specified personality disorder (n = 2),
and psychotic disorder (n = 1).
Findings
Knowledge
The investigators elected to use a 90%
confidence level to maximize pre-post
intervention change sensitivity in a
small sample. As shown in Table 1,
youth knowledge significantly in-
creased at post intervention, as evi-
denced by more correct answers on the
KPIRT (t (17) = -5.19; p = less than .001).
All of the subscales were significant,
particularly prevalence (p = less than
.001). Youth participating in the YES
program showed increased knowledge
about psychiatric illness and rehabili-
tation/recovery from pre-to-post inter-
vention. Hypothesis one appeared to
be confirmed.
Items with the most significant im-
provement from pre-to-post included
the “one in five” prevalence, “psychi-
atric illness is caused by the brain not
working right,” “people with psychi-
atric illness can not be recognized by
looking at them,” “most people do not
get help for their psychiatric illness,”
and “psychiatric illness gets better
with medication and counseling.”
Items that youth answered most cor-
rectly at pre-intervention were: “anti-
stigma programs give the facts of
psychiatric illness,” “psychiatric recov-
ery can affect sleep, appetite, and/or
relationships,” “people who talk about
suicide should not be ignored,” and
“people with psychiatric illness are not
more dangerous than other people.”
Two items showed non-significant de-
clines in youth pre-to-post intervention
knowledge, i.e., “mental health treat-
ment works as well as treatment for
physical health problems,” and “some-
times the causes of psychiatric illness
are not known.”
Coping
A one-tailed, paired-samples t-test
comparing the total instrument pre-in-
tervention mean score (mean = 3.02,
SD = .35) to the post-intervention score
(mean = 3.11, SD = .47) revealed no
significant pre-to-post difference.
Youth participating in the YES program
did not report a significant increase of
coping from pre-to-post intervention.
Hypothesis two was not confirmed.
Two subscales were significant within
the 90% confidence level. At post-in-
tervention, youth reported increased
frequency of avoiding problems (t(17) =
-1.78, sig. = .099) and relaxing (t(17) = -
1.80, sig. = .094). The pre-intervention
coping item that youth rated as occur-
ring most often was avoiding problems
(mean = 4.03, SD = .66). The pre-inter-
vention coping items that youth rated
as occurring least often were seeking
spiritual support (mean = 2.38, SD =
.91) and ventilating feelings (mean =
2.72, SD = .65).
Discussion
This pilot study of a developing inter-
vention follows the groundbreaking
work of Beardslee and colleagues re-
article
137
fa l l 2 0 0 9 — V ol u m e 3 3 N u m b e r 2
garding psychoeducation interventions
for an underserved population, i.e.,
youth with a parent with a psychiatric
illness (Beardslee et al., 2007; Riley et
al., 2008). Youth participating in YES
increased their knowledge of psychi-
atric illness and recovery from pre-to-
post intervention. While youth-reported
coping improved slightly, particularly
for subscales of avoiding problems and
relaxing, overall coping did not in-
crease.
It is important to emphasize that re-
search limitations give reasons for cau-
tion in drawing conclusions from these
early outcomes. The findings cannot be
generalized to other youth of a parent
with a psychiatric illness. All but one of
the participants were Caucasian. The
data were self-reported and not con-
firmed. The KPIRT scale lacks psycho-
metric properties on validity and
reliability. Some youth were involved in
other psychiatric rehabilitation servic-
es. The analyses used a 90% confi-
dence level. However, the major
limitations of this study are the small,
purposive sample and no randomized
control group.
Implications for Future Research
The exploratory nature of this study is
appropriate given the early stage of de-
veloping a new psychoeducation pro-
gram. Future intervention testing
should use more rigorous randomized
designs, as well as a larger, more di-
verse sample. The knowledge scale
should undergo psychometric testing.
It is possible that the treatment dosage
of six youth sessions may not be suffi-
cient to increase youth coping. The pro-
gram design for curriculum content on
coping needs to be enhanced. The cur-
riculum needs to highlight the effec-
tiveness and methods of psychiatric
recovery, particularly as compared to
other health challenges. Family in-
volvement appears to be a major area
for inclusion in subsequent model de-
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Early Outcomes of a Pilot Psychoeducation Group Intervention for Children

Table 1—Youth with a parent with a psychiatric illness participate in multi-family group psychoeducation:
Pre-post intervention youth-reported Knowledge of Psychiatric Illness and Recovery Test (KPIRT)
Category and Items Mean SD Mean SD Paired- Sig.
(Question Number) Percentage Percentage Sample (1-tailed)
Correct at Correct at t-scores
Pre- Post- (df =16)
Intervention Intervention

Prevalence/Incidence

Psychiatric illness (PI) is more common than 70.6 .47 88.2 .33 -1.14 .27
cancer, diabetes, or heart disease (1) a
PI is a major reason for going to the hospital (3) a 41.2 .51 82.4 .39 -2.75 .01**
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Most common PI is anxiety (16) 11.8 .51 41.2 .51 -1.77 .10*
This document is copyrighted by the American Psychological Association or one of its allied publishers.

PI often begins when a person is a teenager 23.5 .44 64.7 .49 -2.38 .03*
or young adult (17)
One of five people experience PI (18) 17.6 .39 88.2 .33 -4.95 .000***
Prevalence Subscale 32.9 .20 72.9 .22 -4.20 .001***
Causes of PI

Brain is not working right (2) a 76.5 .44 76.5 .39 .000 1.00
Cannot catch from someone (5) a 94.1 .24 100.0 .32 -1.00 .33

Children do not cause parent’s illness (6) b 76.5 .44 94.1 .24 -1.8 .08*

Sometimes causes of PI are not known (7) b 94.1 .24 82.4 .42 1.00 .33

Risks of getting PI are genetically higher for 29.4 .47 47.1 .51 -1.4 .19
offspring (8) b
PI is not caused by being a weak person (9) b 58.8 .51 82.4 .39 -1.72 .10*
PI is not caused by having mean parents (14) 76.5 .44 88.2 .33 -1.00 .33
Cause Subscale 72.3 .18 81.5 .14 -2.02 .06*
Functioning

People with PI usually can function well (4) a 35.3 .49 64.7 .49 -2.1 .056*

Stress can make PI symptoms worse (10) 82.4 .93 94.1 .24 -1.5 .16
People with PI can usually think well enough 41.2 .51 58.8 .51 -1.4 .19
to make good decisions (13) a
PI can affect sleep, appetite, and/or 52.9 .51 52.9 .51 .00 1.00
relationships (26)
Functioning Subscale 52.9 .26 67.6 .32 -2.06 .06*
Stigma

People with PI are not more dangerous than 76.5 .44 82.4 .39 -.44 .67
others (11) c
It’s not easy to tell if someone has PI by look- 52.9 .51 94.1 .24 -3.35 .004**
ing at them (12) c
Stigma is thinking people with PI are lazy or 52.9 .51 82.4 .39 -2.1 .06*
stupid (15)
Most homeless people do not have PI (27) 64.7 .49 76.5 .44 -.81 .43
Stigma Subscale 61.8 .29 83.8 .25 -2.50 .02**
Continued on next page

article

138
 fa l l 2 0 0 9 — V ol u m e 3 3 N u m b e r 2

Table 1—Youth with a parent with a psychiatric illness participate in multi-family group psychoeducation:
Pre-post intervention youth-reported Knowledge of Psychiatric Illness and Recovery Test (KPIRT)
Category and Items Mean SD Mean SD Paired- Sig.
(Question Number) Percentage Percentage Sample (1-tailed)
Correct at Correct at t-scores
Pre- Post- (df =16)
Intervention Intervention

Psychiatric Rehabilitation

Most people with PI do not get help for their 29.4 .47 76.5 .44 -3.77 .002***
illness (19) a
Mental health treatment usually works as well 58.8 .51 52.9 .51 .32 .75
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

as treatment for other health problems (20) a

This document is copyrighted by the American Psychological Association or one of its allied publishers.

A major reason people with PI do not get help 47.1 .51 76.5 .44 -2.58 .02**
is feeling ashamed of the illness (21) a
Severe PI often gets better with medication 35.3 .49 70.6 .47 -2.95 .009**
and counseling (22)
People with depression often feel better with 41.2 .51 58.8 .51 -1.00 .33
sunlight, exercise, eating healthy foods, and
talking to friends (23)
People who talk about suicide should not be 76.5 .44 82.4 .39 -.44 .67
ignored (24)
Anti-stigma programs help people learn 76.5 .44 76.5 .44 .000 1.00
about the facts of PI (25)
Rehabilitation Subscale 52.1 .22 70.6 .22 -2.72 .02**

Total 55.3 .13 75.4 .15 -5.19 .000***

KPIRT

Notes: N is 17; Significance: p=≤.10*, p=≤.02**, p=≤.002***

a
Adapted from Alaska Mental Health Board (2004)
b
Adapted from Sherman and Sherman (2006)
c
Adapted from Center for Addiction and Mental Health (2001)

velopment and testing. These findings
are not surprising or discouraging. In
light of the significant improvement in
youth knowledge of psychiatric illness
in only six sessions, as well as the po-
tential to increase program sessions
devoted to coping skills, there is limit-
ed, but suggestive, evidence to warrant
pursuing additional groups and contin-
ued data collection.
This study raises many future research
questions. What are the barriers to,
and facilitators of, recruitment of youth
for psychoeducation groups? How can
youth and parents be identified within
mental health services? Do youth out-
comes improve with model tweaking,
e.g., more sessions, parent sup-
port/inclusion, and simultaneous addi-
tional services to the youth, parent,
and/or family? Does family psychoedu-
cation for youth help parents in recov-
ery from a psychiatric illness? Should
other interventions and/or “packages”
of interventions be developed and test-
ed (Place, Reynolds, Cousins, & O’Neill,
2002)? Finally, there is a need for lon-
gitudinal research to learn more about
youth knowledge, coping, and func-
tioning over time, e.g., what are the
long-term outcomes of youth psycho-
education?
Implications for Practice and Policy
The data support the need for profes-
sionals to provide more information for
consumers of all ages and their family
members about psychiatric illness and
recovery. It is important that adult pro-
grams address parenting as a key life
role within psychiatric rehabilitation
and recovery. At the very least, adults
in recovery should be asked if they
have children and whether they would
like to include this life role within their
recovery plans. This data should rou-
tinely be included within intake and
services planning. Both adult and child
services professionals should consider

article

139
 P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l
ways to increase youth access to pre-
vention programs. Some of the stigma-
tized views of illness demonstrated by
this sample of youth may indicate a
need for more macro anti-stigma pro-
grams for school-age youth.
Summary
At this early stage of a youth psychoed-
ucation pilot study, the main contribu-
tion of the findings to the field of
psychiatric rehabilitation is working
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
out the logistics of implementing this
type of intervention for an underserved
population of children of a parent with
a psychiatric illness. Future studies are
likely to use experimental designs,
larger samples, and longer interven-
tions. Youth outcomes, rising from
more enduring interventions and re-
search rigor, could build knowledge
about the extent that psychoeducation
may help strengthen youth protective
factors in the quest for developmental
resilience. If so, there will be evidence
for implementing prevention and early
intervention programs for children of a
parent with a psychiatric illness.
Early Outcomes of a Pilot Psychoeducation Group Intervention for Children
References
Alaska Mental Health Board (2004). Test your
knowledge of mental illness. Retrieved
electronically 12-19-2006 from
www.hss.state.AK.US/amhb/docs/MHQui
z.pdf.
American Academy of Child and Adolescent
Psychiatry [AACAP] (2004). Children of
parents with mental illness, no. 39.
Washington, D.C.: Author. Obtained elec-
tronically 10/23/2007 from: aacap.org.
American Psychiatric Association [APA].
(2004). Diagnosis and statistical manual
of psychiatric disorders (TR). Washington,
D.C.: Author.
Beardslee, W. R. (2002). Out of darkened room:
Protecting the children and strengthening
the family. New York: Little, Brown.
Beardslee, W. R., Wright, E. J., Gladstone, T. R.
G., & Forbes, P. (2007). Long-term effects
from a randomized trial of two public
health preventive interventions for
parental depression. Journal of Family
Psychology, 21(4), 703–713.
Beardslee, W. R., & Gladstone, T. R. G. (2000).
The prevention of depression in at-risk
adolescents: Current and future direc-
tions. Journal of Cognitive Psychotherapy,
14, 9–23.
Cannon, T. D., Cadenhead, K., Cornblatt, B.,
Woods, S. W., Addington, J., Walker, E., et
al. (2008). Prediction of psychosis in high
risk youth: A multi-site longitudal study in
North America. Archives of General
Psychiatry, 1, 28–37.
Centre for Addiction and Mental Health (2001).
Talking about mental illness: A guide for
developing an awareness program for
youth (p. 70). Toronto: Author. Retrieved
12-18-2006 from:
http://www.camh.net/education/Resourc
es_teachers_schools/TAMI/tami_teachers
resource.html#top.
Clarke, A. T. (2006). Coping with interpersonal
stress and psychosocial health among
children and adolescents: A meta-analy-
sis. Journal of Youth and Adolescence, 35,
11–24.
Corcoran, K., & Fischer, J. (Eds.) (2000).
Measures for clinical practice: A source-
book (3rd Ed.) New York: The Free Press.
Cowling, V. (Ed.). (1999). Children of parents
with mental illness. Melbourne, VIC,
Australia: The Australian Council for
Education Research.
article
140
Dixon, L., McFarlane, W. R., Lefley, H.,
Lucksted, A., Cohen, M., Falloon, I., et al.
(2001). Evidence-based practices for serv-
ices to families of people with psychiatric
disabilities. Psychiatric Services, 52,
903–910.
Eskandanri, M. R., Karami, S., Sharifi, H., &
Taheri, F. (2007, March). Parent oriented
psychoeducation for under age 5 years
children with stubbornness. European
Psychiatry, 15th AEP Congress, Abstract
Book, S207.
Fristad, M. A., Goldberg-Arnold, J. S., Gavazzi,
S. M. (2003). Multifamily psychoeducation
groups in the treatment of children with
mood disorders. Journal of Marital and
Family Therapy, 29, 491–504.
Gearing, R. E. (2008). Evidence-based family
psychoeduational interventions for chil-
dren and adolescents with psychotic dis-
orders. Journal of Canadian Child and
Adolescent Psychiatry, 17, 2–11.
Hampel, P., Meier, M., & Kümmel, U. (2008).
School-based stress management training
for adolescents: Longitudinal results from
an experimental study. Journal of Youth
and Adolescence, 37, 1009–1024.
Handley, C., Farrell, G. A., Josephs, A., Hanke,
A., & Hazelton, M. (2001). The Tasmanian
Children’s Project: The needs of children
with a parent/carer with a mental illness.
Australian and New Zealand Journal of
Mental Health Nursing, 10, 221–228.
Henin, A., Biederman, J., Mick, E., Sachs, G.,
Hirschfeld-Becker, D. R., Siegel, R. S., et
al. (2005). Psychopathology in the off-
spring of parents with bipolar disorder: A
controlled study. Biological Psychiatry, 58,
554–561.
Hinden, B., Biebel, K., Nicholson, J., &
Mehnert, L. (2002). The Invisible
Children’s Project: A family-centered inter-
vention for parents with mental illness.
Worcester, MA: Center for Mental Health
Services Research. Obtained electronically
7/28/05 from
www.mhaorangeeny.com/icipweb.htm.
Hogarty, G. E., Anderson, C. M., & Reiss, D. J.
(1990). Family psychoeducation, social
skills training, and maintenance
chemotherapy in the aftercare treatment
of schizophrenia II. Two year effects of a
controlled study on relapse and adjust-
ment. Archives of General Psychiatry, 48,
340–347.
Lenz, A. (2005). Children’s ideas about their
parents’ psychiatric illness: An explorative
study. Praxis Der Kinderpsychologie und
Kinderpsychiatrie, 54, 382–398.

Leverton, T. J. (2003). Parental psychiatric ill-
ness: The implications for children.
Current Opinion in Psychiatry, 16,
395–402.
Maybery, D., Ling, L., Szakacs, E., & Reupert,
A. (2005a). Children of a parent with a
mental illness: Perspectives on need.
Australian e-Journal for the Advancement
of Mental Health Nursing, 4(2), 2–11.
Maybery, D., Reupert, A., Patrick, K.,
Goodyear, M., & Crase, L. (2005b).
VicHealth research report on children at
risk in families affected by parental mental
illness. Melbourne, Victoria, Australia:
Victorian Health Promotion Foundation.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Miklowitz, D. J., Simoneau, T. L., George, E. L.,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Richards, J. A., Kalbag, A., Sachs-Ericsson,
N., & Suddath, R. (2000). Family-focused
treatment of bipolar disorder: 1-year ef-
fects of a psychoeducational program in
conjunction with pharmacotherapy,
Biological Psychiatry, 48, 582–592.
Östman, M., & Hansson, L. (2002). Children in
families with a severely mentally ill mem-
ber: Prevalence and needs for support.
Social Psychiatry and Psychiatric
Epidemiology, 37, 243–248.
Patterson, J. M., & McCubbin, H. I. (1987).
Adolescent coping style and behaviors:
Conceptualization and measurement.
Journal of Adolescence, 10(2), 163–186.
Peisah, C., Brodaty, H., Luscombe, G., &
Anstey, K. J. (2002). Children of a cohort of
depressed patients 25 years later:
Psychopathology and relationships.
Journal of Affective Disorders, 82,
385–394.
Place, M., Reynolds, J., Cousins, A., & O’Neill,
S. (2002). Developing a resilience package
for vulnerable children. Child and
Adolescence Mental Health, 7, 162–167.
Pölkki, P., Ervast, S. A., & Huupponen, M.
(2004). Coping and resilience of children
of a mentally ill parent. Social Work in
Health Care, 39, 151–163.
Pollio, D. E., McClendon, J. B., North, C. S.,
Reid, D., & Jonson-Reid, M. (2005). The
promise of school-based psychoeducation
for parents of children with emotional dis-
orders. Children & Schools, 27, 111–115.
Riebschleger, J. (2004). Good days and bad
days: The experiences of children of a par-
ent with a psychiatric disability Psychiatric
Rehabilitation Journal, 28, 25–31.
Riebschleger, J. (2006). Knowledge of
Psychiatric Illness and Recovery Test
(KPIRT). Unpublished instrument.
fa l l 2 0 0 9 — V ol u m e 3 3 N u m b e r 2
Riley, A. W., Valdez, C. R., Barrueco, S., Mills,
C., Beardslee, W., Sandler, I., & Rawal, P.
(2008). Development of a family-based
program to reduce risk and promote re-
silience among families affected by mater-
nal depression: Theoretical basis and
program description. Clinical Child and
Family Psychological Review, 11, 12–29.
Ruffolo, M. C., Kuhn, M. T., & Evans, M. E.
(2005). Support, empowerment, and edu-
cation: A study of multiple family group
education. Journal of Emotional and
Behavioral Disorders, 13, 200–212.
Sherman, M. D., & Sherman, D. M. (2006). I’m
not alone: A teen guide to living with a
parent who has a mental illness. Edina,
MN: Seeds of Hope.
Smith, C., & Carlson, B. E. (1997). Stress, cop-
ing, and resilience in children and youth.
Social Service Review, 71, 231–256.
Smith, D., Muir, W., & Blackwood, D. (2003).
Genetics of early-onset depression. The
British Journal of Psychiatry, 182,
363–364.
Van Breda, A. D. (2001). Resilience theory: A
literature review. Pretoria, South Africa:
South African Military Health Service.
Downloaded 1/15/2009 from
http://www.vanbreda.org/adrian/resilien
ce.htm.
Joanne Riebschleger, PhD, LMSW, Assistant
Professor, School of Social Work, Michigan
State University (MSU).
Betty Tableman, MPA, Outreach Specialist,
University Outreach and Services (MSU).
Danielle Rudder, LLMSW, Research Specialist,
School of Social Work (MSU).
Esther Onaga, PhD, LMFT, Associate
Professor, Dept. of Family and Child Ecology
(MSU).
Peg Whalen, PhD, MSW, Director of Research
& Evaluation, Alliance for Children &
Families, Milwaukee, WI.
Contact:
Joanne Riebschleger, PhD, LMSW
School of Social Work
Michigan State University
254 Baker Hall
East Lansing, MI 48824
P: 517-353-9746
F: 517-353-3038
Email: riebsch1@msu.edu
article
141