FORGOTTEN CHILDREN:
WHICH PROBLEMS WITH THE FIRST
ITALIAN EXPERIENCE?
I. Brusa , A.Cerri, E.Re, F.Tasselli
XI WAPR World Congress Milano 10-13 november 2012
WHY PREVENTION?
Shochet et al 2001
Associazione CONTATTO Onlus Milano
PREVENTION IS MORE EFFECTIVE AND
ECONOMIC
THAN
WAITING AND TREATING PSYCHOLOGICAL
PROBLEMS OF THE CHILDREN WHEN THEY
APPEAR
THE ILL PARENT
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is absorbed by his thought and emotions :
can’t put attention to people around him
“I don’t know to do with the baby”, “I can’t do anything” :
feeling of inadequacy
“before I was fine, he’s the cause of my problems”,
“he scares me” :
feeling of the baby as a problem for him
“all is ok “, “all is going worse” :
loss of the critic, he’s hypo o hypercritic
THE CHILD
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“mom doesn’t care me because I’m bad” :
feeling of guilty
“I don’t know what I’ve to do”, “I can do it by myself”:
feeling of impotence or omnipotence
“these homework are necessary, if I don’t do them, nobody
does” :
he charge himself of too much responsibility
“I’ve to protect my mom “, “ I must keep the secret” :
he develops two identity levels
Children experience can include

I’m the cause of the problems, and my father doesn’t love
me anymore
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if I were different , all could be better
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I hate my parents !
Parent experience can include

I’m not good father/mother
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If I were not here, all could go better

How many trioubles with the children !
Professional experience can include
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Poor child ! what kind of parents !!
My little patients have not to suffer cause the parents !
Tytti Solantaus, 2010
“LITTLE FLOWERS IN SESTO”
(PICCOLI FIORI IN SESTO)
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a pilot project took place from 2010 to 2011
in Milano by NGO “Contatto Onlus ”, in partnership with Adult
and Child Mental Health Services of Sesto S.Giovanni
6-14 y.o. children of adults treated by the local adult CMCH
The aim : to evaluate and increase protective factors and the
relationships in and out of the family, using a natural social
networks activation approach
Associazione CONTATTO Onlus Milano
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starting from Adult Mental Health System
EXPECTED RESULTS
AND OUTCOMES ACHIEVED:
On the contrary we received from the service
just 16 referrals and we were able to treat just
6 families.
Associazione CONTATTO Onlus Milano
In the Sesto San Giovanni CMCH:
26.4% of patients between 25 and 55 years old,
(A.V. 97) had children under 18, so we
expected to be able to include a high
number of families.
Professionals referred only
high pathological families
Associazione CONTATTO Onlus Milano
We couldn’t work following
a perspective of prevention
THIS RESULT WAS PROBABLY THE EFFECT OF
CULTURE OF CARE IN MENTAL HEALTH
SERVICES:
the focus on the adult patient picked out from his
environment
 the attitude to consider some patient abilities
(like occupational or domestic skills),
neglecting parental competences
 the fear of stigmatizing the patient
 the supposed risk of interference in the
therapeutic relationship
MOREOVER:
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the offer of the program was focused on the child
social network and not addressed to the whole
Ass CONTATTO
family
Onlus Milano
SEMOLA PROGRAM
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It will be realized in Milano by
Contatto Onlus”, in partnership with
Adult Mental Health Services of
Niguarda Ca’ Granda and San Carlo
Hospitals and La Tartavela,
association of family members.
it is funded by the Municipality of
Milan
Associazione CONTATTO Onlus Milano
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After a specific training and after going
deeply in the literature, we conceived a
new preventive project, that will
take place in 2013 and 2014
THE PROGRAM HAS BEEN REFOCUSED AND
RESHAPED IN ORDER:
to extent the intervention to the whole family
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to extend the recruitment to a larger population
we agreed with CMHC professionals a strict
procedure in order to cooperate to recruit all the
recruitable families, keeping the difference
between CMHC professionals and the special team
in terms of competence and roles
Associazione CONTATTO Onlus Milano
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APPROACH
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We will follow the Finnish approach of
T.Solantaus (Let’s Talk intervention, Family Talk
Intervention, Vertti Group)
We will also maintain our traditional intervention
on the natural social network of the child
We involve family member associations , but for
the moment we choose not to formally involve
other services or the general population
Associazione CONTATTO Onlus Milano
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FLOW CHART – SEMOLA PROGRAM
TARGET:
Every new
patient with
children 6-14
FIRST INTERVIEW
(PSYCHIATRIST W COWORKER)
c
LET’S TALK (1 - 3 sessions )
(CW WITH A TRAINED PSYCHOLOGIST)
No other
intervention
FAMILY TALK
INTERVENTION
VERTTI
GROUP
NATURAL
SOCIAL
NETWORK
ACTIVATION
Associazione CONTATTO Onlus Milano
FIRST NURSE
INTERVIEW
TENDENCIES AND PROBLEMS
OF SERVICES
…IGNORANCE, FEAR, ABSTINENCE !!!
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not to consider children problems
fear to stigmatize their patient as bad parent
fear to ruin the relationship with the pt
to consider this problem not as a competence of
adult psychiatry, but of infant psychiatry
formally correct, but altogether inadequate
cooperation among services involved
(health/social, adult/infant, hospital/clinics)
weak services system governance and no
mandatory preventive programs by health local
authority or health/welfare ministry
TOWARD A MULTILEVEL AND
MULTITASK INTERVENTION
mentally ill person
symptoms
abilities
therapy
rehabilitation
parental couple
relational dynamics
parental competences
family therapy
parentood education
family at large
relational dynamics
interpersonal communication
socio-economical conditions
therapy
psychoeducation
socila support
child living with
psychological frialty
relational problems
material problems
school performance
support to the resilience
support to the social
network
learning support
school contest and
neighbourood
stigma
marginalization
information campaigns
inclusive actions
general culture and
social capital
stigma
marginalization
information campaigns
inclusive actions
Stop thinking that talking about problems could
be dangerous !!
TALKING ABOUT PROBLEMS LET
PEOPLE BE BETTER !!!!
Don’t wait !!
TO PREVENT
IS BETTER THAN TO TREAT !!!!