CLINICAL HANDBOOK OF SCHIZOPHRENIA

478 VI. SPECIAL POPULATIONS AND PROBLEMSA U.S. survey identified approximately 20 programs specifically developed for parentswith mental illness (Hinden, Biebel, Nicholson, Henry, & Katz-Leavy, 2006),repesenting a variety of theoretical frameworks and treatment approaches, from a residentialrehabilitation model with on-site family services and supports, to a therapeuticnursery program with support services for parents, to hospital-based inpatient and clinicservices, to community-based comprehensive case management services. Interventions offeredby these programs may include:• Parenting classes. These are didactic sessions in which parents can learn basicknowledge about parenting (e.g., child nutrition, sleep patterns, behavior shaping, anddevelopmental norms).• Parenting coaching. In this form of dyadic or family therapy, a therapist, or coach,teaches parenting skills directly to parents. Techniques can include the coach “speaking”for a nonverbal child to help train parents to understand nonverbal cues, role modelingeffective parenting behaviors with the parent practicing them, or praising effective behaviorsthat parents exhibit naturally, so as to encourage and further develop those strengths.• Parent support groups. Parents may be encouraged to give each other parentingtips, to role-model effective behaviors for one another, and to problem-solve together toovercome obstacles to effective parenting.• Coparenting support. A relative or friend may serve as a coparent, with specificdelineation of roles for the parent and the coparent with respect to the child and to eachother. Such arrangements may include plans for progressive assumption of the parentingrole by the parent as rehabilitation proceeds.Using Existing Treatment Resources to Support ParentsAdults who do not have access to specific programs for parents with SMI can benefitfrom the adaptation of existing resources to support parental functioning. Evidencebasedpsychosocial interventions for adults with mental illness, though not specificallytested with parents with schizophrenia, suggest strategies that may prove effective. Forexample, assertive community treatment (ACT) services can address parenting as a roledomain, and help to build skills and access resources. Family psychoeducation programscan address the education and communication needs of parents with schizophrenia andtheir children. Skills training interventions for adults with mental illness can be adaptedto include parent skills training. Symptom self-management strategies can be modified totake the sometimes competing demands of parenting into consideration.Barriers to Treatment for Parents with Schizophreniaand Their FamiliesParenting responsibilities may compromise treatment adherence by either interfering withappointments with providers or thwarting compliance with treatment recommendations(e.g., medications and hospitalization). For example, parents may not take medicationsthat make them lethargic in the morning if they must prepare breakfast and get childrenready for school. Mothers with SMI may delay hospitalizations if they have no child care.Consequently, parents may be labeled “treatment resistant” or “noncompliant” by providersor family members when they are in fact choosing to prioritize what they perceiveas the demands of parenthood.Many treatment settings are not designed to encourage or support family contact.Clinic reception areas may not be child-friendly; treatment settings may not be able to