BART's Place for Children and Teenagers of Parents With Serious Mental Illness

Children tearfully waving to their hospitalized parents from the parking lot of a psychiatric hospital. Psychiatric inpatients talking about the difficulty of being away from their children. Such situations were the impetus for creating BART's Place at the Northcoast Behavioral Healthcare System in Cleveland, an acute care psychiatric hospital operated by the Ohio Department of Mental Health. The program, whose name stands for Bringing All Relatives Together, serves hospitalized patients who are parents and their children, grandchildren, and siblings who are under age 18.

During the four and a half years of its existence, BART's Place has been privileged to host 349 family sessions. The program has been recommended as a best practice by the Ohio department and has been embraced by the National Alliance for the Mentally Ill (NAMI) of Ohio.

BART's Place, named after a bear puppet, was opened in 1995 because we were aware that the children of our patients were often overlooked in the shuffle of the patient's mental health crisis. We knew that a great proportion of our patients were parents and that illness, hospitalization, and frequent separations had deleterious effects on patients, children, caretakers, and other family members. We knew that children were told little, if anything at all, about their parent's mental illness.

We also knew that the children themselves were at risk for developing mental illness over the course of their lives. Furthermore, we were aware from recent research that a treatment focus on the patient as a parent increased the likelihood of the patient's medication compliance both during and after hospitalization and that patients wanted mental health professionals to develop methods to evaluate and intervene on behalf of their children. We expanded the concept of BART to include grandchildren and siblings under 18 as well as children of the patients.

Physically, BART's Place is a family-friendly playroom located on the ground floor of the hospital, away from units that are inappropriate settings for children to visit. At the time of admission, patients who have children, grandchildren, or siblings under age 18 are referred to the BART psychologist, who completes an initial assessment. With the patient's permission, the psychologist interviews the children's caretakers, usually by telephone, to gather information about the children's understanding of the family member's hospitalization and what the children have or have not been told.

When the patient is considered stabilized, a family session, including caretakers, is arranged. All sessions are supervised and facilitated by the psychologist. The patient is both supported and encouraged to explain the symptoms, diagnosis, and treatment of the illness to the children in age-appropriate terms. Children are encouraged to express their concerns and their feelings. Frequently, discharge agreements made at the session incorporate the children's insistence that the parent will take the prescribed medication. Polaroid pictures of parents and children are taken for the children to take home and for the parents to keep at the hospital, as most of our patients and their children do not have photographs of each other. A little stuffed BART bear often accompanies the children home as well.

Patients, children, and caretakers alike have expressed gratitude for being able to spend this valuable time together and to have their questions answered patiently and respectfully by a mental health professional. Families are encouraged to call the psychologist if they have further questions or problems, and they may come back for a family session after the patient is discharged.

BART has been supported by grants from private foundations and by the hospital itself. In 1999 the program expanded to the community; in collaboration with NAMI of Ohio, BART's Place KidSupport groups began. Children aged six to 18 who have mentally ill parents or siblings are referred from the inpatient program and from schools and other community agencies for a series of five weekly sessions. The curriculum focuses on education about mental illness, expression of feelings about the illness, and peer support for the children in a safe atmosphere. The groups are held in community settings such as churches and schools. Parental permission is required for children to attend, and parents are not present.

In the KidSupport program, older teens will be trained to be peer support buddies. The BART concept and the KidSupport groups are being expanded to other state inpatient facilities and community mental health services in Ohio. A research study focusing on assessment and treatment of the children of parents with serious mental illness is under way.

Ms. Katz is director of the BART's Place program. When this report was written, Mr. Gintoli and Dr. Buckley were affiliated with the program. Mr. Gintoli is currently director of mental health for South Carolina in Columbia, and Dr. Buckley is chairman of the department of psychiatry at the Medical College of Georgia in Augusta. For further information, contact Ms. Katz at Northcoast Behavioral Healthcare System, 1708 Southpoint Drive, Cleveland, Ohio 44109 (e-mail, [email protected]).