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Tele-coaching

For the parents of children with mental health issues, help is now just a phone call away
August 3, 2011
Patricia Lingley-Pottie (LEFT) Jillian Kennedy
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Patricia Lingley-Pottie (LEFT) Jillian Kennedy (CENTRE), and Patrick McGrath with some of the materials coaches use to help parents deal with their children?s behaviour issues over the phone.
John Sherlock

Children in Nova Scotia who suffer from disruptive behaviour, anxiety disorders or other moderate mental health issues often fail to receive timely access to psychological care. It can take up to a year to see a psychologist for treatment. Dalhousie University psychologist Patrick McGrath is developing a tele-medicine-style solution to help these children and their parents cope.

McGrath, Vice President, Research, at IWK Health Centre in Halifax, and his colleagues studied whether non-professional “coaches” talking to parents over the phone would significantly reduce the proportion of children with symptoms of disruptive behaviour or anxiety disorders compared to those receiving usual care. It did.
 
A grant from the Canada Foundation for Innovation (CFI) funded the initial development of software for running the original trials. “The funding was critical to developing the system of care that we now are using,” says McGrath. The Canadian Institutes of Health Research (CIHR) also provided funding—some for studies directly related to the tele-parenting program and some for testing interventions that may have widespread use in the future. The research team worked with 243 children with mental health issues such as attention-deficit/hyperactivity disorder and anxiety disorders. The team equipped parents with handbooks and videos and provided 10 weekly coaching sessions by phone.

To deal with disruptive behaviour, the coaches taught parents to notice and reward their children for good behaviour. “They teach them to have high expectations, but also high warmth,” says McGrath. And to deal with anxiety, coaches offered parents and children the skills to effectively cope when exposed to their fears and prevented from escaping them. “You have to face your fears,” says McGrath.

The trials showed that there was a low dropout rate, high satisfaction among the participating parents and improved behaviour among children. Compared with usual care, the tele-treatments resulted in a significant reduction in disruptive behaviour and anxiety. Parents typically end up building strong relationships with their coaches, most of whom have experience working with families, either as volunteers or camp counsellors.

McGrath likens the approach to tele-medicine, but instead of a diagnosis or treatment, recipients get parenting skills. And the program is economical. “It requires only weeks to train a coach compared to the years it takes to train a psychologist,” says McGrath. “It is also less expensive than traditional services for the health system and also for the families.”

Parents find the telephone appointments to be convenient and flexible, says Patricia Lingley-Pottie, the program’s clinical manager. “Most schedule the sessions in the evening so children don’t have to miss school and parents don’t have to take time off work.” The system also allows participants to have visual anonymity, which is important to families. “They feel comfortable being in their own home,” she says, “and they don’t feel as if they’re being judged.”

“The work that emanated from our CFI grant has gone beyond academe,” says McGrath. “Today, children and families are being treated in Halifax, rural Nova Scotia and Ontario and Alberta with the methods we developed.” Soon, families in British Columbia and even northern Finland will begin using this new approach.
 
The tele-parenting program has already helped more than 1,500 families across Canada. This summer, McGrath and his team are spinning off their research into a non-profit organization, the Strongest Families Institute, which will allow them to further disseminate their research findings. They expect the system to spread widely over the next few years.