Rahvusvaheline konverentsi. Rehabilitatsiooni tulemuslikkuse môôtmine.

Tartu 31.10.2007

Evaluation of d development of psychiatric family rehabilitation for children and adolescents

- preliminary results.

Pirjo Lehtoranta, Centre for Rehabilitation R & D, Rehabilitation Foundation, Helsinki, Finland

Ritva Linnakangas, Asko Suikkanen and Aila Järvikoski, University of Lapland, Rovaniemi, Finland

1. Background

About 20% of Finnish school age children have some degree of psychiatric disorders. The most typical psychiatric disorders for children are attention deficit disorders, and behaviour and oppositional defiant disorders, which can also appear at the same time. Other typical problems are depression and anxiety disorders. Boys have more disorders than girls. Boys have general disturbance, behaviour and ADHD disorders. Girls have more disorders of affect. (Almqvist et al. 1999, Kumpulainen et al. 2000).

Adolescence is a typical starting time for many mental problems. It has been found that about half of mental problems of adults beganhave begun before 14 years, and three- quarters before 24 years of age.

Mental problems appear more usually in adolescence than in childhood, and more in later than in early adolescence. In early adolescence (12-14 year olds) problems are more usual for boys than for girls, but later they appear later more inby girls. (Aalto-Setälä, Marttunen 2007.)

15-25 % of adolescents suffer from long-term symptoms (Haarasilta et al. 2000). Typical for the mental disorders of adolescents is that many of them appear at the same time. For example, a significant part (40-80%) of depressive adolescents also suffer also from other mental disorders, usually anxiety disorders, attention and behaviour disorders, or substance abuse. Anxiety disorders may be related to depression and somatic symptoms. Behaviour disorders can also be related to crimes and substance use. (Aalto-Setälä & Marttunen 2007.)

A study of the views of public health nurses of everyday problems of families and their needs for special support shows that about one-third of the families are considered to have a pressing need for support. Half of the families have difficulties in coping with parenthood, almost aone third with raising their children and with childcare. A fifth of the families have problems connected to children’s development, growth and health. (Häggman-Laitila & Euramaa 2003.)

To improve the situation, the Finnish Social Insurance Institution (SII) started the discretionary psychiatric family rehabilitation for children and adolescent. The evaluation task of the development work of the projects was done by the University of Lapland and the Rehabilitation Foundation.

2. Psychiatric family rehabilitation projects

SII funded eleven projects in different parts of the country to support the child/adolescent and his/her family and to develop new models for psychiatric family rehabilitation. The target group of the projects are 5-15 year old children and, also exceptionally, 16-25 year old adolescents who are in need of psychiatric rehabilitation. Children or adolescents with a diagnosed psychiatric disorder and with what was considered to be an adequate doctor-patient relationship were granted access to rehabilitation. According to SII, these family rehabilitation projects should be based on multi-professional teamwork and cooperation with local municipal services and hospital districts.

The evaluation task of the development work of the projects is carried out by the University of Lapland and the Rehabilitation Foundation.

2. Psychiatric family rehabilitation initiated (or started)granded by The Finnish Social Insurance Institution (SII)

SII has organised discretionary psychic family rehabilitation for children and adolescent from the year 2000. The projects are widespread widely inspread over different parts of Finland. The target group of the projects are 5-15 year old children and, also exceptionally, 16-25 year old adolescents, who are in need of psychiatric rehabilitation. The children/adolescents have to be diagnosed withby a psychiatric disorder and to have a doctor-patient relation before they are referred to rehabilitation.

Objectives of the projects set by SII are:

  • to improve and secure the action- and learning ability of children
  • to support interaction in the family
  • to support the family in its raising task of raising children
  • to tighten upand improve co-operation of projects, local services (e.g. municipality child guidance and family counselling) and hospital districts (21)
  • to use multi-professional work to develop new models for psychiatric family rehabilitation

The rehabilitation can be outpatient or inpatient rehabilitation. The content can vary from action oriented rehabilitation and therapies to peer groups and networks. The rehabilitation can be offered to the child/adolescent, to the groups of children/adolescents or parents, or to the whole family. In any caseAnyway, the family should be involved in some waytaking with. The rehabilitation can last from 1 to 2 years.

3. Objectives and Data of Evaluation task

Evaluation is targeted at the implementation of the 11 multi-professional family rehabilitation projects and their outcomes (2006-2009). The evaluation consists of:

(a)description of the implementation models of the projects,

(b)description of the target group (children and adolescents).

(c)outcomes of family rehabilitation at the individual and family level

(d) data on co-operation between projects and their networks.

The evaluation is based on realistic evaluation principles. The questions asked being, e.g. what works with whom, when, and in which circumstances.

Evaluation data is gathered from the project workers, children / adolescents themselves and their parents, and the organisations within the cooperation network. Both quantitative and qualitative data is used.

4. Results

In conference some preliminary results will be presented, concerning

  • examples of projects’ implementations
  • the target group (the children/ adolescents)
  • the outcome evaluation of those families whose rehabilitation process has ended

Pirjo Lehtoranta

Rehabilitation Foundation

Pakarituvantie 4, 00410 Helsinki


phone +358-9-5304264