Supporting Siblings and Parents of Children with Behavioral Challenges

Educational Consultants
Foreword by Carl Fulwiler
Preface

Introduction

Chapter 1: Sibling Support Program: Principles, Structure, and Implementation

Chapter 2: Getting Started

Chapter 3: Parent Mentors and Caregiver Group Work

Chapter 4: Sibling Support Group Work

Chapter 5: Logistics and Resources

Chapter 6: Confidentiality, Security, and Permissions

A Final Word to Readers

Appendix A: Sibling Support Program Sample Surveys

Appendix B: Sibling Support Program Sample Documents

References
Index
Acknowledgments
About the Author

Emily Rubin, LICSW, MSW, MA, developed the Sibling Support Program: A Family-Centered Mental Health Initiative (SSP), the program on which this book is based. Rubin is a clinical social worker with a background in teaching, curriculum development, writing, and research. She is director of sibling support at the Eunice Kennedy Shriver Center and on the psychiatry faculty at UMass Chan Medical School in Worcester, Massachusetts. She is also on the psychiatry faculty at Harvard Medical School and is a part-time teaching associate in child and adolescent psychiatry at The Cambridge Hospital in Cambridge, Massachusetts. Rubin’s research examines the impact of a child’s mental health challenges on their siblings and caregivers, and strategies to build resiliency and decrease trauma within these families. Rubin received the Excellence in Family Leadership Award for “making a significant impact in the field of children’s mental health.” She is founder emeritus of the Massachusetts Sibling Support Network, a 501(c)(3) nonprofit organization addressing the needs of siblings of people with all kinds of disabilities across the sibling lifespan. Rubin has a part-time psychotherapy practice and has published and presented her work nationally and internationally.

Rubin provides consultation to assist individuals and groups with SSP implementation and staff training. She is also available for speaking engagements and professional development workshops and can be reached at emilyrubinlicsw@gmail.com.

For too long, clinicians treating children with behavioral and mental health needs have been without adequate guidance on how to support siblings and caregivers affected by the challenging child’s behavior. Emily Rubin has now provided just such a blueprint. Drawing on years of pioneering clinical work, research, and insight, she has developed a compelling and cost-effective model that focuses on building resiliency and decreasing trauma among family members and strengthening the family unit. Furthermore, the book provides exceptional training for clinicians who want to learn the principles of delivering family-centered mental healthcare. This is a book that every clinician who works with families of challenging children should have on their bookshelf.

— Annie Murphy Paul, author of The Extended Mind

“Emily, you have trained a generation of Cambridge Health Alliance psychiatrists to be attentive to the needs of siblings and families as an essential element of caring for our patients. I have learned so much from you over the years and have been so grateful for the opportunity to work with you on this project.”

— Louis Ostrowsky, MD, Harvard Medical School

As chair of Harvard Medical School’s Department of Psychiatry at Cambridge Health Alliance (CHA), I have the privilege of working with clinicians, educators, and trainees who are deeply committed to advancing equitable, compassionate, and family-centered mental healthcare. The Sibling Support Program: A Family-Centered Mental Health Initiative (SSP), developed by Emily Rubin, is one of the most innovative and impactful interventions I have seen emerge from our clinical programs. It is a powerful example of how recognizing an unmet need — in this case, the distress and trauma often carried by siblings of psychiatrically hospitalized children — can lead to the creation of a model that not only fills a critical gap in care but also transforms how we train future mental health professionals and how we support entire families.

Emily, a clinical social worker and educator with a primary appointment at UMass Chan Medical School, developed the SSP in 2011 and piloted it on the inpatient child psychiatry units at The Cambridge Hospital. Her vision was rooted in both research and clinical insight: Siblings of children with serious behavioral health challenges are at heightened risk for anxiety, depression, PTSD, and emotional isolation, yet they rarely receive attention or support from mental health systems. Emily set out to create a structured, trauma-informed program that offers parallel support groups for siblings and caregivers, co-led by trainees, clinicians, and trained parent mentors. The result is a uniquely effective and scalable intervention that lifts the entire family system.

At CHA, the SSP has become a deeply valued component of our child psychiatry inpatient services. Just as importantly, it has become a sought-after training experience for psychiatry residents, child psychiatry fellows, and psychology and social work interns. As the findings from our internal trainee study demonstrate, participation in the SSP significantly strengthens trainees’ confidence in family-centered approaches and increases their intention to incorporate this perspective into their future practice. Residents often describe their time co-leading the sibling groups as one of the most meaningful parts of their training. In the words of one trainee, “Being a part of the sib support group has been a pivotal part of my residency experience and really cemented my desire to pursue child fellowship.” Another reflected, “I will definitely inquire about siblings of patients and if they are receiving enough support of their own.” These comments speak to the lasting impact the program has on those who deliver it — as well as those who receive it.

The voices of families speak to another powerful impact. One caregiver described the parent group as “the only place in my life where I don’t have to sugarcoat what’s happening in my family.” A 12-year-old sibling shared, “At the end of these groups, I feel so happy, like a big weight has been lifted off my chest.” These testimonials speak to the deep loneliness and emotional burden that many siblings and caregivers carry — and to the profound relief that comes when those burdens are named, shared, and held in community. The SSP not only helps families feel seen but also equips them with concrete strategies to support one another and to cope more effectively in the face of behavioral health crises. One of the most remarkable aspects of this program is its adaptability. Although it began in the inpatient hospital setting, the SSP has been successfully implemented in multiple settings outside the hospital environment. It is structured yet flexible. It is evidence-informed yet grounded in real-world experience. It centers families without pathologizing them. This is precisely the kind of intervention we need more of in today’s mental health landscape: low-cost, scalable, peer-informed, and humane.

This book reflects Emily Rubin’s years of clinical work, research, teaching, and program development, and it offers a clear and practical road map for replication. It also invites clinicians, educators, systems leaders, and community members to widen our lens; to pay closer attention to the family members and loved ones of children with serious emotional disturbance; and to recognize that when we support the whole family, we create the strongest foundation for a child’s ongoing growth and recovery.

Carl Fulwiler, MD, PhD, chair and chief
Harvard Department of Psychiatry at Cambridge Health Alliance
Associate Professor, Harvard Medical School
Cambridge, MA