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summer 2004—Volume 28 N umb er 1
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Good Days and Bad Days:
The Experiences of
Children of a Parent
with a Psychiatric
Disability
▼
Joanne Riebschleger
Twenty-two children, ages 5 to 17, described their experiences living within a family
that included a parent with a psychiatric disability who was involved in community
Joanne Riebschleger, PhD, MSW,
is an Associate Professor in
the Department of Sociology,
Anthropology, and Social Work and
the College of Humanities and Social
& Behavioral Sciences of Central
Michigan University. She is a family
member of people with psychiatric disabilities, a social work educator, and
a mental health practitioner. The
author thanks those who supported
the original study for this secondary
analysis, i.e., former employer
Northern Lakes Community Mental
Health Services; the Michigan State
University Institute of Children,
Youth and Families (partial funding);
and former research colleagues Paul
Freddolino, Barbara Kanaga, and
Jennifer Miller.
Address Correspondence to:
Joanne Riebschleger, PhD, ACSW
Associate Professor
Dept. of Sociology, Anthropology
& Social Work
College of Humanities and Social &
Behavioral Sciences
Central Michigan University
038 Anspach Hall
Mt. Pleasant, MI 48859
Work: 989/774-2607
Fax: 989/774-2140
[email protected]
mental health agency services. The children’s descriptions of parents’ “good days”
and “bad days” were captured in a secondary data analysis of a study that
included face-to-face children’s interviews. Children also discussed their
perceptions of psychiatric disabilities and rehabilitation. Children reported more
attention from parents on “good days.” They expressed concerns about multiple
family stressors and bias associated with psychiatric disability. They had little
information about psychiatric disabilities and/or rehabilitation. Children
recommended “Get help earlier.”
“Hugs and no drugs.
Then drugs and no hugs.”
Ten-year-old Amanda (pseudonym)
wrote this poem 6 months before the
suicide of her mother of an overdose of
medication. This study asked children
like Amanda to describe what it is like
to live in a family that has a parent with
a psychiatric disability. Twenty-two
children described “good days” and
“bad days” within the family that
roughly aligned with the children’s perceptions of the daily acuity of a parent’s psychiatric symptoms. Children
described how they felt and acted on
good days and bad days. They talked
about their knowledge of psychiatric
disability and their perceptions of psychiatric rehabilitation services.
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25
There is growing recognition that many
people with psychiatric disabilities are
parents. One in four people with psychiatric disabilities receiving public
mental health services in the state of
New York have children and the parenting rates are about 45% for young
women (NYSOMH, 1997). Risk-oriented
research studies to identify and prevent the presumed transmission of a
psychiatric disability from parent to
child began to appear in the practice
literature about 25 years ago (Ross &
Compagnon, 2001). The transmission
was thought to be through either genetic (“nature”) and/or parenting
(“nurture”) mechanisms (Benjamin,
Benjamin & Rind, 1998). Some studies
focused on child resilience (Ennis,
Reddon & McDonald, 1999; Marsh
et al., 1996). Others emphasized
Good Days and Bad Days
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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
stressors on the family, e.g., poverty,
substance abuse, violence, and unemployment (Mowbray, Schwartz &
Bybee, 2000; Seifer et al., 1996). Some
recommended increased support for
parenting roles within psychiatric rehabilitation (Mowbray et al., 2000).
Others reported parents with psychiatric disabilities expressed concern
about systemic bias that could lead to
losing custody of their children
(Joseph, Joshi, Lewin & Abrams, 1999;
Riebschleger, Freddolino, Kanaga &
Miller, 1993). A few studies asked adult
children to reflect upon their childhood
experiences growing up in a household
where one parent had a psychiatric disability (Kinsella, Anderson & Anderson,
1996).
There is little research that identifies
the experiences and needs reported by
minor children of a parent with a psychiatric disability. Bohus et al. (1998)
claimed that there were “scarcely any
exchanges” between mental health
providers and children of people with
psychiatric disabilities. Riebschleger,
Freddolino, Kanaga, and Miller (1993)
claimed that the children of parents
with a serious psychiatric disability
were “invisible” to the mental health
services system. Information about
newly evolving demonstration programs for children appeared in the
mental health practice literature
(Handley, Farrell, Josephs, Hanke &
Hazelton, 2001; Katz, Gintoli &
Buckley, 2001).
Findings from the few studies that examined the needs and experiences of
children of a parent with a psychiatric
disability found evidence of significant
child coping behaviors and unmet
needs for integrated community-based
services (Handley et al., 2001). Teenage
children of parents with depressive
symptoms reported that they struggled
to understand their parents’ psychiatric disabilities and they were impact-
ed by separations during parents’ hospitalizations (Garley, Gallop, Johnston
& Pipitone, 1997).
Methods
This study was a secondary analysis of
data generated in an earlier study of
the reported needs of children with a
parent with a psychiatric disability
(Riebschleger et al., 1993). The purpose
of the secondary study reported herein
was to explore a child’s eye view of
living day to day in a family that included a parent with a psychiatric disability. Children described their knowledge
of a parent’s psychiatric disability and
their perceptions of psychiatric rehabilitation services. The study intended
to build practice knowledge from
the unique perspectives of a little researched group — children as children,
i.e., under age 18.
Twenty-two children were accessed
from three prevention programs located in three community mental health
agencies in northeast, southwest, and
central Michigan. The children had at
least one parent with a psychiatric disability who participated in services at a
community mental health agency. The
sample included 11 boys and 11 girls
who were from 5 to 17 years (mean =
9.36). The sample included four
African-American, three Latino/
Hispanic, and 15 Caucasian children.
Mental health professionals reported
that most of the parents with a psychiatric disability were Medicaid recipients; this implies limited household
income. Most of the children lived in
single parent families.
Limited data was collected about the
parents of the children, although it was
reported by mental health staff that the
children had a mother with a psychiatric disability (n=12), a father with a
psychiatric disability (n=5), and both
parents with a psychiatric disability
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26
(n = 5). Reported parent mental health
diagnoses appeared to be primarily
mood disorders, e.g., bipolar affective
disorder and major depression (n= 16),
as well as schizophrenia (n=4), posttraumatic stress disorder (n=1), and
not known (n=1).
Nine of the children were interviewed
face to face within their family homes.
Two of the interviews took place at the
office of the prevention services staff
person. Eleven of the children were interviewed in a focus group at an elementary school.
The interview questions were developed and revised per the recommendations of participants in the original
study, i.e., parents with psychiatric disabilities, children of people with psychiatric disabilities, mental health
professionals, and child welfare professionals. The question frame and
flexible probes asked the children to
describe their behavioral responses,
feelings, and family events on the family’s and/or parent’s “good” and “bad”
days (good days = children’s perceptions of lower levels of acuity of a parent’s psychiatric symptoms). Other
questions/probes explored the children’s knowledge of their parent’s
psychiatric disability, and their perceptions of psychiatric rehabilitation.
The interviews and focus groups were
audiotaped and fully transcribed. The
data were analyzed with the open,
axial, and selective coding system recommended by Strauss and Corbin
(1990). Data coding within the finding
themes was tested to achieve an interrater reliability of .91.
Results
Data about children’s views of living
within a family with a parent with a
psychiatric disability were categorized
into four main themes. These included
good days, bad days, views of psychi-
summer 2004—Volume 28 N umb er 1
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
atric disability, and perceptions of psychiatric rehabilitation.
Good Days
Good days were defined as days when
the parent with a psychiatric disability
was “doing well.” Eighteen of the 22
children tended to view good days as
times that parents interacted more frequently with them. Children described
“feeling happy” when a parent “reads
me a story,” “watches TV with me,”
“helps me with my homework,” and
“plays a game with me and my brother.” One child reported that he knew
his mother was doing well when, “We
went to the beach a lot.”
Children described good days as times
of increased communication with the
parents, e.g., “My dad asks, ‘What
happened at school today?’; and “We
talk at the table.” Children reported
more affection from parents on good
days, e.g., “When I get home from
school…my mother is hugging me and
saying, ‘I missed you.’ An 11-year-old
reported, “We would go out to eat and
we would…hold conversations.”
Children identified what appears to be
increased parental completion of daily
tasks. A 13-year-old girl described good
days for her parent as times when the
parent was able to perform household
activities: “Well, when she’s doing
well…she’s doing the dishes and the
housecleaning and other stuff and
when she’s not feeling well she’s always asking me to cook and for me to
do the laundry and stuff…She’s not just
sitting there.” Three of the children
said that their parents were doing well
when “(She or he) can go to work”
and “We don’t have to worry about bills
so much.”
Bad Days
Bad days were defined as days when
the parent with a psychiatric disability
was “not doing as well.” Six children
described bad days as times when
their parents were less attentive to the
child, with more withdrawn behaviors.
A 12-year-old girl said, “They (parent)
don’t talk to nobody; they’re real quiet.
They just sit on the couch. They ask
‘how are you doing?’ and that’s about
it.” A 10-year-old boy described it similarly, “(A bad day is) when she is not
talking a lot…She wouldn’t be there a
lot.” A 10-year-old girl said, “She would
want to be left alone. Sometimes she
would sit around all day with her nightgown on or (spend) all day in bed.
Sometimes I could leave and come
back and find the door locked and she
wouldn’t let anyone in, stuff like that.”
Eleven children described bad days as
times when their parents were more
likely to be “grumpy,” with more
“yelling” behaviors. When asked to describe a bad day, children said, “My
mom starts yelling at me” and “When
we all yell at each other.” A girl described a recent event, “Last night I got
up and they (parents) were yelling at
each other.” A 5-year-old boy said a
bad day is when “You can see her face.
Her face looks mad.” A 17-year-old girl
said, “He had a temper that would last
about 30 seconds and when he was so
mad at you, you were scared of him.” A
15-year-old youth said, “Any little thing
would set him off.”
When children were asked to described
parental “bad days,” most of the children immediately offered information
about their own reactive behaviors. The
most frequently cited child responses
were ignoring, avoiding, and/or attempting to reduce the family stress by
increasing caregiving behaviors. A girl
reported that on bad days, “I ignore it.
That’s what I do. I ignore it and when
it’s hard to ignore, I go into my bedroom and shut the door.” An 11-yearold male described trying to “be quiet”
and “I go into my room and listen to
the radio.” A 5-year-old male said, “I
leave her alone so she won’t be mean
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27
to me.” A 13-year-old girl listed her behaviors on bad days, “I try not to talk to
her so that she doesn’t get upset and
get worse. I try not to tell her things
that would get her upset. …(I) make
sure my room’s really clean, I do the
dishes and make supper…I go in my
room…or I go to a friend’s house.” Six
of the children described caring for
younger siblings, e.g., “When Mom
gets sick, I’m responsible for (younger
brother) so he doesn’t get in trouble…
and that he heads right home.”
Some of the children reported feelings
of sadness and worry. A 10-year-old
boy reported, “I don’t really like it
when she’s having a bad day because
it gets me down and I just don’t cry
about it cause I know if she gets any
worse she’ll have to go to the hospital…I usually just lay down or something to see if it gets better…I feel kind
of nervous in school too.” Several children reported worrying about parental
suicide behaviors and possible out of
home care if the parent were to be hospitalized. One youth was so concerned
about “being put in foster care” that he
insisted on using a pseudonym within
the interview of this study.
Children’s Descriptions of Psychiatric
Disabilities
The children tended to focus on what
the parent’s psychiatric disability
meant to them within day-to-day interactions with their parents. For example, children viewed parental
withdrawn behaviors not as psychiatric
disability symptoms, but as less attention from parents. Similarly, irritability
on the part of parents with mood
disorders was viewed by children as
“yelling” which often led to children’s
reported behavioral responses of ignoring, avoiding, and/or engaging in
caregiving to reduce family/parental
stress. During times when parental
psychiatric symptoms escalated, some
children reported fears of parental
Good Days and Bad Days
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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
hospitalization and/or suicidal behaviors. Some children appeared afraid of
being moved to another’s home, e.g.,
foster parent or extended family member. Some appeared to be afraid of losing their parent. Indeed, ten of the
children had lived with relatives or
friends when their parents were hospitalized. Three of the children had been
placed in foster care when their parents were hospitalized. One child described his experience, “She had to go
to the transition house so we don’t
have no family here and no one Mom
can really trust, so she put me in foster
care for a few weeks.” Two of the
children who spent time in foster care
complained about the rules and restrictions, “They (foster parents) treated
me like I was some kind of delinquent
or something. I didn’t do anything
wrong.”
The children who appeared to have
some understanding of their parent’s
psychiatric disability were asked what
they knew about the parent’s psychiatric disability and how they found out
about it. Only a few of the children offered a diagnostic label, e.g., “She has
depression;” and “My dad has manicdepression.” Most of the children gave
behavioral descriptions of a person
with a psychiatric disability, such as
“You have to take a lot of medicine,”
“You act real weird,” and “You can’t
reason with a mentally ill person.” One
girl said, “What I see as mental illness
is that you don’t get all your facts
straight and you are slow at most
things you do. You don’t catch on as
fast.” An 8-year-old boy talked about
his mother, “She just cries. And then
she just sits there. That’s depression.”
A 12-year-old girl described her father’s
symptoms of schizophrenia, “He
just…talks about nonsense things like
aliens and wicked stuff and all that
weird kind of jazz that, you know, just
don’t really jive.”
Although one child reported that when
she was 10 years old her mother “sat
us down and she told us she has a
problem,” most of the children reported never having been told about their
parent’s illness until they entered the
prevention program. For example, one
child said: “Then I started seeing (mental health worker) and I started talking
to her about it (parent’s psychiatric disability).” Five children described learning about the parent’s psychiatric
disability slowly over time as they
began to compare their family to the
families of their friends. One said,
“For quite a while I knew (Dad) had a
problem, but I just didn’t know about it
(psychiatric disability). I didn’t know if
it was normal or not normal, but I knew
it was different.” Four of the children
reported that the parent’s behavior
was a “family secret,” “not something
we talk about in my family,” and
“something we kept to ourselves.”
Only two children reported talking
about their parent’s illness with
friends.
The children appeared to be very aware
of reactions to psychiatric disabilities.
One child expressed dismay at the
treatment of people with psychiatric
disabilities, “I think it (psychiatric disability) is something that other people
think bad about…Lots of people get
teased. Like in my mom’s case, she
was made fun of.” A 9-year-old girl
asked poignantly, “I would like to know
if people treat you differently if you
have [a] mental illness or if they treat
you like others?”
Children in this study often reported
that a parental psychiatric disability
was merely a part of a number of concerns in their lives. In a closing question about what the children wished for
in their lives, the children reported that
the parental psychiatric disability was
less worrisome to them than other
stressors in their lives, particularly
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poverty and parental divorce. For example, three of the children voiced concerns about their family “not paying
bills,” “kids tease me and call me a
“poor kid,” “I wish my family had more
money,” and “I wish my mom would
get a good job.” Sixteen of the children
lived in single parent families. A number of the children expressed concern
about parental divorce, e.g., “I wish I
could see my dad more,” and “My first
wish would be that my mom and dad
would get back together and not fight
so much.”
Other concerns of the children included
a sibling running away from home, a
brother’s illness, the death of a grandparent, being teased by peers, or not
doing well in school, etc. The children
said: “I wish my brother didn’t have to
go to chemotherapy”; “I wish I could
see my grandpa whenever I wanted
to”; and “I wish I could get my little
dog back.” The children in the study
had moved frequently in their lives.
One teenage male said, “You know,
we counted it up once. We moved seventeen ti …
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