การพัฒนาระบบบริการสุขภาพจิตผู้ปกครองของเด็กและวัยรุ่นที่มีปัญหาสุขภาพจิตและพัฒนาการ

Soontaree  Srikosai; Uraiwan  Wongpothi; Nutpimol  Wongmueang; Anongporn  Thakham

doi:10.60099/jtnmc.v38i02.261791

Authors

Soontaree Srikosai Rajanagarindra Institute of Child Development (RICD)
Uraiwan Wongpothi Rajanagarindra Institute of Child Development
Nutpimol Wongmueang Rajanagarindra Institute of Child Development (RICD)
Anongporn Thakham Rajanagarindra Institute of Child Development (RICD)

DOI:

https://doi.org/10.60099/jtnmc.v38i02.261791

Keywords:

system development, mental health services, guardians, children and adolescents

Abstract

Introduction The mental health service system for guardians of children and adolescents with mental health and developmental problems remains unclear. Screening is not adequately covered, leading to limited access to services for guardians with mental health issues and a lack of links between service units.

Objectives To develop and test the efficiency and effectiveness of a mental health service system (MHSS) for guardians of children and adolescents with mental health and developmental problems, using a brief psychosocial intervention program based on the Satir model (BPST).

Design Research and Development

Methodology The study was conducted in five stages between January 2020 and December 2022: Stage 1 - Needs assessment and analysis; Stage 2 - Designing the mental health service system for guardians; Stage 3 - Creating the MHSS model; Stage 4 - Testing the efficiency of MHSS in terms of benefits and service quality among 65 guardians, selected by purposive sampling, who received services under the MHSS between June and August 2021; Stage 5 - Testing the effectiveness of BPST among 54 guardians who participated in the MHSS, randomly assigned to either experimental or control groups. The experimental group (n = 27) received the BPST program three times, while the control group (n = 27) received brief counseling using problem-solving principles (BCPS) three times. Outcomes were measured by evaluating guardians' mental health (stress, anxiety, and depression), children's emotional, social, and behavioral problems, family relationships, and satisfaction with services received. Data were analyzed using descriptive statistics, Independent t-test, Mann-Whitney U test, and Friedman test.

Results The MHSS consisted of 1) an initial screening by nurses, 2) evaluation, diagnosis, and treatment provided by psychiatrists, and 3) reassessment of guardians’mental health status and provision of psycho-social therapy by nurses. The service system's efficiency was demonstrated through guardians' reduced stress and anxiety, mental support, multidisciplinary collaboration, and the application of service providers' knowledge and expertise. In terms of quality, 68% of guardians received services as expected. The effectiveness of BPST showed lower anxiety ( 2 = 8.909, p = .012), stress ( 2 = 22.092, p < .001), depression ( 2 = 28.871, p < .001), children's emotional, social, and behavioral problems ( 2 = 19.809, p < .001), and improved family relationship ( 2 = 10.533, p = .005) in the experimental group across three time-points. While the control group showed an increase in anxiety ( 2 = 9.100, p = .011) and children's emotional, social, and behavioral problems ( 2 = 9.771, p = .008) after completing the program. These symptoms decreased at the 1-month follow-up, and there was an improvement in family relationships ( 2 = 37.829, p < .001). However, no significant difference was observed in stress and depression. On the other hand, the experimental group experienced greater satisfaction with the services (M = 2.67, SD = 0.25, Mean rank = 13.36) compared to the control group (M = 2.35, SD = 0.07, Mean rank = 3.00) (Z = -2.017, p = .043) after the program completion.

Recommendations The MHSS has been developed to effectively and efficiently support guardians of children and adolescents with mental health and developmental problems. Psychiatric and mental health nurses can implement the BPST to alleviate mental health problems among guardians and improve emotional, social, and behavioral problems in children, as well as enhance family relationships.

Author Biography

Soontaree Srikosai, Rajanagarindra Institute of Child Development (RICD)

Ph.D. (Nursing)

References

Medical records sector, Rajanagarindra Institute of Child Development: Outpatient service recipient statistics, fiscal year 2018, 2019, 2020. Rajanagarindra Institute of Child Development, Department of Mental Health, Ministry of Public Health; 2020. (in Thai)

Family Mental Health Promotion Clinic. Report on the analysis of data from routine work. Family intervention clinic, fiscal year 2018. Rajanagarindra Institute of Child Development; 2018. (in Thai)

Family Mental Health Promotion Clinic. Report on the analysis of data from routine work. Family intervention clinic, fiscal year 2018-2020. Rajanagarindra Institute of Child Development; 2020. (in Thai)

Bitsika V, Sharpley CF, Bell R. The buffering effect of resilience upon stress, anxiety and depression in parents of a child with an autism spectrum disorder. Journal of Developmental and Psysical Disabilities 2013; Springer Published Online:1-11. doi: 10.1007/ s10882-013-9333-5

Zablotsky B, Bradshaw CP, Stuart EA. The association between mental health, stress, and coping supports in mothers of children with autism spectrum disorders. J Autism Dev Disord 2013; 43:1380-1393. doi: 10.1007/s10803-012-1693-7

Chalotorn P. Prevalence and associated factors of depression among the primary caregivers of patients with ADHD at Chaophrayayommarat Hospital in Thailand. Region 4-5 Medical Journal 2021; 40(3): 429-438. (in Thai)

Emerson E, Brigham P. Health behaviours and mental health status of parents with intellectual disabilities: cross sectional study. Public Health 2013; 127: 1111-1116.

Mensah FK, Kiernan KE. Parents’ mental health and children’s cognitive and social development. Social Psychiatry and Psychiatric Epidemiology 2009; Springer Published Online:1-13. doi: 10.1007/s00127-009-0137-y

Suphapitiporn S. Stress of parents of children with disabilities who bring their children to receive services at the central special education center, Bangkok [master’s thesis]. Bangkok: Chulalongkorn University; 2012. (in Thai)

Samartzis L, Dimopoulos S, Tziongourou M, Nanas S. Effect of psychosocial interventions on quality of life in patients with chronic heart failure: A meta-analysis of randomized controlled trails. J Card Fail 2013; 19(2):125-134.

Czaja S J, Loewenstein D, Schulz R. A videophone psychosocial intervention for dementia caregivers. Am Assoc Geriatr Psychiatry 2013; 21(11):1071-1081.

Saraceno B, Ommeren M, van Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Global Mental Health 5; 2007. [Published online]. Available from: www.thelancet.com

Limsuwan N, Limsuwan N. Psychotherapy using the Satir Model. Journal of the Psychiatric Association of Thailand 2012; 57(3), 251-258. (in Thai)

Srikosai S, Donnok P, Taweewattanapreecha S, Saipanich R. Clinical manifestations and adherence to medication. of ADHD and harmony in parents' lives after receiving the Satir model mental health education program. Journal of the Psychiatric Association of Thailand 2018; 63(3):227-246. (in Thai)

Department of Mental Health. Scores according to criteria for research, development and utilization of innovation/technology in mental health and psychiatry of the agency KPI 24 Department of Mental Health Strategic Issue 2: Developing the quality of mental health and psychiatric service and academic systems Dimension 3 Performance dimensions. Details indicators according to the performance certification of the agency Fiscal Year 2019 Department of Mental Health; 2019. (in Thai)

Waiyawut S. Research design: research and development (R&D) and action research models participatory (PAR). Power point assembly training. “Create a new generation of researchers” (chicks), generation 7. The National Research Council of Thailand together with Naresuan University. Date 14-18 January 2019; 2019. (in Thai)

Department of Mental Health. Mental health test. Available from: https://dmh.go.th/test/ (in Thai)

Kittirattanapaiboon P, Khamwongpin M. The validity of the mini international neuropsychiatric interview (M.I.N.I.)-Thai version. Journal of Mental Health of Thailand 2005; 13(3):125-135. (in Thai)

Kongsuh A, Arunpongpaisal S, Janthong S, Prukkanone B, Sukhawaha S, Leejongpermpoon J. Criterion validity of the 9 questions depression rating scale revised for Thai central dialect. Journal of the Psychiatric Association of Thailand 2018; 63(4):321-334.

Srikosai S, Wongpothi U, Wongmuang N, Thippanya K, Takham A, Khamfu C, et al. The validity and reliability of the brief family relationship scale (BFRS) for applying in Thai youth. Journal of the Psychiatric Association of Thailand 2022; 67(4):329-341. (in Thai)

Masulani-Mwale C, Mathanga D, Kauye F, Gladstone M. Psychosocial intervention for parents of children with intellectual disabilities-A narrative review and implications for low-income setting. Ment Health Prev 2018; 11:24-32.

Ningsanon C, Yontrajitphakdi N, Thaotang W. Writing workflow. Training documents. Faculty of Medicine Siriraj Hospital Mahidol University; 2021. (in Thai)

Safarabadi-Farahani A, Maarefvand M, Biglarian A, Khubchandani J. Effectiveness of a brief psychosocial intervention on quality of life of primary caregivers of Iranian children with cancer: A randomized controlled trial 1, 2. Journal of Pediatric Nursing 2016; 31(4):e262-e270.

Charoenchaiyaporn T. Correlation of knowledge and stress level among parents of children with autism [Independent Study]. Chiang Mai: Chiang Mai University; 2011. (in Thai)

Jongpaisansakul P, Suppapitiporn S. Stress of custodians of disabled children who attend special education center of the central region, Bangkok. Chulalongkorn Medical Journal 2014; 58(3): 355-369. (in Thai)

Burrell TL, Borrego J. Parents' involvement in ASD treatment: What is their role? Cogn Behav Prac 2012; 19:423-432.

Srikosai S, Dornnork P, Somchai C, Sriseub P, Taweewattanaprecha S, Saipanish R. Clinical outcome and parents’ life congruence of children with autism spectrum disorder after a Satir model based psychoeducational program. International Journal of Child Development and Mental Health 2019; 7(2):41-54. (in Thai)