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På grunn av koronapandemien og økt digitalisering i samfunnet, har digital veiledning fått mer oppmerksomhet. Det er likevel begrenset forskning på fordelene og utfordringene ved å flytte veiledning til digitale plattformer. Studien undersøker veilederes erfaringer med digital veiledning gjennom en spørreundersøkelse. Fordeler ved veiledning på digitale flater var hovedsakelig knyttet til praktiske faktorer som tidsbruk og mulighet for gjennomføring på tross av geografisk avstand mellom veileder og veisøker. Utfordringer handlet hovedsakelig om at etablering av tillit syntes vanskeligere og begrensninger i bruk av forskjellige veiledningsmetoder. Resultatene viste en tydelig tendens til at veilederne foretrakk fysisk veiledning framfor digital, selv om flere hadde gode erfaringer med veiledning på digitale flater. Det var de eldste og mest erfarne veilederne som var mest positive til digital veiledning. Studien viser at flere veiledningsmetoder fungerer godt ved digital veiledning. Digital veiledning har både fordeler og ulemper, og kan være et godt alternativ til fysisk veiledning.

Abstract Introduction High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (

Abstract Background Children of parents with a mental illness are at high risk of developing a mental disorder as a result of transgenerational transmission. Without effective intervention, they could form the next generation of psychiatric patients. ChildTalks+ is a preventive intervention involving four structured psychoeducational sessions designed for parents affected by a mental disorder and their children. Its aim is to reduce the risk of mental disorders in children of parents with mental illness. This study draws on our clinical practice and involves a group of patients with eating disorders. The aim of the project, which will run in the Czech Republic, is to evaluate the effectiveness of ChildTalks+ methodology. Methods ChildTalks+ therapists (professionals from health, social, and educational facilities) will recruit 66 families where a parent is treated for a mental disorder and the family includes children aged 6–18. Paired allocation into an intervention group (N = 33) and a control group (N = 33) will be based on the number of risk factors identified in the family. Both groups will complete questionnaires at the baseline, post-test, and follow-up assessments after six and 12 months. The intervention group will receive the ChildTalks+ intervention within 2 months of the baseline assessment; the control group after the last assessment. Questionnaires will be completed by parents and children aged 12+ and, in two cases, 15+ years. Quantitative data will be supplemented with qualitative data from ChildTalks+ therapists working with patients with eating disorders. Discussion The ChildTalks+ intervention is expected to strengthen parenting competencies and family protective factors, improve family communication, increase awareness of parental mental health issues, and improve the wellbeing of children of parents with mental illness with long-term sustainable outcomes. The study should contribute to the evidence base for the ChildTalks+ program and help identify key themes in the implementation of similar preventive interventions. Trial registration ClinicalTrials.gov Identifier: NCT05554458. Registered 26 September 2022. Retrospectively registered.

IntroductionChildren of parents with a mental illness (COPMI) are at risk of behavioral, emotional, and cognitive difficulties and diagnoses. Support and information about parents’ mental illness may contribute to improve their lives, which is the purpose of the intervention Child Talks (CT). This study aimed to investigate the participation rate of CT, characteristics of participating patients and children, and themes in sessions with children.Materials and MethodsData were collected from 424 electronic patient journals written by healthcare professionals (H) for patients admitted to a clinic for mental health and substance use disorders in the years 2010–2015. Both quantitative statistical analysis and qualitative thematic analysis were carried out.ResultsEighteen percent of assessed parents with minor children received the CT intervention and children participated in half of them. Participating children more often knew about their parent’s treatment and condition when initially assessed, and more often lived with the hospitalized parent. Three main themes were identified in sessions with children; communication about parental mental illness within the family, childrens’ struggles, and healthcare professionals’ (HCPs) evaluation of the child’s situation and need for further support.DiscussionSessions with patients’ children appeared to be relatively rare, and participating children did not necessarily receive appropriate information, support, or follow-up. To ensure that HCPs provide quality support and follow-up to COPMI, the routines and the training of HCPs need to be improved.

BackgroundParental mental health and substance abuse problems are found in reports of concern to child protection and welfare services. The aim of this study was first to investigate what characterized these reports and how they differed from reports with other types of concerns. Two hypotheses were tested. The first hypothesis was (i) if a report contains concerns about mental health and substance abuse problems, the likelihood of service provision was mediated by substantiation status. The second hypothesis was (ii) that the threshold for substantiation of such problems differed depending on child age, single parent status, and the presence of other child and parent related problems.MethodThe study was designed as a case file study which was carried out retrospectively (N = 883). A conceptual model was tested in two steps. First a mediation model with direct and indirect paths from reports of concerns through substantiation decision to service provision was tested. Then a second model was expanded to also include moderators for the indirect effects of reported concerns on substantiation decisions.ResultsA total of 33.1% of reports about substance abuse and 41.7% of reports about parental mental illness concerns were provided services. The first hypothesis was confirmed. There is a negative direct effect and a positive mediated effect of reported concern on service provision. The second hypothesis was not confirmed. We failed to identify any significant moderating effect of child age, single caregiver status, or number of child problems, upon the threshold for substantiation of mental health and drug abuse problems.ConclusionsThe total effect of reports about mental illness and substance abuse upon service provision was low. Service provision in cases with suspected substance abuse and/or mental illness is highly dependent upon substantiation of that specific problem. Substantiation threshold is not impacted by other case characteristics. This is surprising because there are good theoretical reasons to assume that parental drug abuse and or mental illness are potentially more detrimental to child health, development and safety if the child is younger, if the parent is a single caregiver, and there are many other parallel concerns.

Background:According to amended legislation implemented in Norway in 2010, personnel in healthcare services for adults are obligated to identify patients' minor children and to assess the family situation. Health personnel is also obligated to contribute to adequate support to families affected by parental mental illness or substance use disorders. The intention behind the amendment was to support and protect children of mentally ill parents, as they are at risk of developing problems of their own. The aim of the present study was to evaluate health personnel's practice during the years 2010-2020, more specifically; (a) to what extent children of patients with mental illness and substance use disorders are registered in patient records, and (b) to what extent activities relating to the assessment and support of patients' minor children are documented in patient records.Method:The participants in the study are patients admitted to Division for Mental Health and Substance Use at the University Hospital of North Norway in the years 2010–2020. The data was drawn from patient records during October 2021.Results:The registration of patients' minor children is considerably strengthened since the introduction of the new Norwegian Health Personnel Act in 2010, and estimates show that 56% of patients' minor children are identified. However, only 31% of cases where patients have identified minor children this result in health personnel performing activities to support the children.Discussion:Based on the rising proportion of identified minor children throughout the 10-year period, it seems evident that the dissemination efforts have contributed to the development of some new skills among health personnel. However, compared with the national estimation that 35% of mentally ill and substance abusing patients have minor children, a large proportion of children remains unidentified. After identification, there seem to still be a long way to go before minor children are systematically offered support. Different solutions to strengthen the implementation of new skills in clinical practice, to ensure the identification of minor children and provision of necessary support for them is discussed.

Background: Parental mental health problems is a common source of concern reported to child welfare and protection services (CWPS). In this study we explored to what extent the child was invited to participate in the investigation process. We aimed to study: (a) what was the current practice in the child protection service in Norway when the CWPS received a report of concern about children whose parents were affected by mental health problems or substance abuse, (b) to what extent were children involved and consulted, (c) which factors predicted the decision to involve the children, and (d) in cases in which conversations with children were conducted: what was the main content of the conversations.Method: The study was a cross-sectional case file study (N = 1,123). Data were collected retrospectively from case records in 16 different child protection agencies. The cases were randomly drawn from all referrals registered in the participating agencies. Differences in how investigations were conducted in cases with and without concerns about parental mental health were analyzed using t-tests and chi-square testes. Predictors of child involvement in cases with parental mental health problems (N = 324) were estimated by logistic regression analyses.Results: When the referral to the CWPS contained concerns about parental mental health, there were more consultations with parents, more frequent home visits and the investigation took longer to conclude. The children, however, were less likely to be involved. Children in such cases were consulted in 47.5% of cases. Predictors for involving the children in those cases were child age, concern about the child's emotional problems and if the child was known from previous referrals.Conclusion: In Norwegian child protection investigations, in which there were concerns about the parent's mental health, conversations with children were conducted to a significantly lower degree compared to cases where the child's problem was the main concern. In such cases, the CWPS workers have to overcome a threshold before they consult with the child. The threshold decreases with child age and when case worker already knows the child.

Abstract Background Previous research has shown a link between parental mental illness and adverse development in their offspring. In Norway, it is mandatory for health professionals to identify if patients in adult mental health services have children, and subsequently to provide support for the children. An important tool to detect if families are affected by parental mental illness and to assess if there is a need for further intervention is the Family Assessment Conversation. Family Assessment Conversations is potentially a powerful tool for communication with families affected by parental mental illness because it facilitates early identification of children at risk of various adversities due to the family situation. Additionally the tool may initiate processes that enable children and parents to cope with the situation when a parent becomes seriously ill. Little is however known about how the mental health practitioners use the family assessment form in conversations, and to what extent they record relevant information in the electronic patient journals. Methods The main aim of the study was to provide information about the existing practice within mental health services for adults in terms of parental mental illness and family assessment conversations. The project is a retrospective journal review. The data base consists of relevant journal data from 734 patients aged 20–60 years admitted. In total, 159 recordings of family assessment conversations were discovered. Results The main result in this study was that many of the questions in the family assessment form lacked documented responses and assessments from the healthcare professionals. Only 17% of the participants had been assessed with the total family assessment form. Additionally, there was a lack of documentation about whether or not the children had been informed in a large proportion of the assessment forms (31%). A total of 55% say that the child has not been informed. This implies that there is still a long way to go in order to make sure that children of parents with a mental illness are given relevant information and support. Conclusions The documentation and family assessment frequency is low and reflects the challenges healthcare professionals and patient experience when the child’s situation becomes the topic of assessment. There is a need to further investigate the challenges of changing the mental health systems to incorporate the children and families of patients. More research should promote knowledge on what may facilitate family assessment dialogue.

Background: The main objective of this project is to create a research and intervention model to promote large-scale implementation and evaluations of generic very brief interventions for children of parents with mental disorders (COPMI). Feasible interventions for COPMI aged 0–18 years are highly needed, as this is a large high-risk group in society. Reducing behavioral problems and enhancing wellbeing for families with parents affected by any mental disorder are important preventive initiatives. One key prevention strategy is to reduce the risk and expression of psychopathology in children and to promote wellbeing. The present model protocol offers an intervention for children of parents with mental disorders internationally based on a model already implemented in the Netherlands and Norway.Methods: Participants will be parents receiving treatment in mental health services in participating countries and their minor children aged 6–18 years. Participants should be randomized into an intervention group or control group. Data should be retrieved from electronic patient journals (demographics, DSM 5/ICD-10, SCID, MINI) as well as from assessment measures administered at baseline and follow-up, including the KIDSCREEN-27, Strengths and Difficulties Questionnaire (SDQ), Parents’ Evaluations of Developmental Status (PEDS), Parenting Sense of Competence (PSOC), Resilience Scale for Adolescence (READ), Guilt and Shame Questionnaire for Adolescents of Parents with Mental Illness (GSQ-APMI), Mental Health Literacy Scale, and Parent–Child Communication Scale.Results: The hypothesis is that there will be improvements of child behavioral and emotional problems, and outcomes in the project will be reported in terms of parent´s diagnosis, child behavioral and emotional problems, child wellbeing, family communication and functioning, as well as participants’ satisfaction.Discussion: This multi-site international protocol will focus the attention of European scientific and policy makers toward COPMI. This young segment of the population is presently almost completely neglected in most European health policies, despite having a large burden of disability and being at risk of transgenerational transmission of psychopathology. We will further discuss the feasibility of a very brief intervention aiming at preventing mental disorders in young people.

Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents’ psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. “Semente,” a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in “Child Talks” intervention (two to three psycho-educational meetings with parents and children) and implementation of the “Semente” program.Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals’ attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later.Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest.Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the “Semente” program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the “Semente” program.

Background: The main objective of this study was to identify and describe core life circumstances of children with mentally ill parents (COPMI) and their parents. Knowledge about COPMI aged 0–17 years is necessary, as assessment of the risk and protective factors in their lives provide solid background for preventive interventions.Methods: Participants (N = 422) were parents of minor children (N = 589) receiving treatment in the clinic for psychiatric illness and substance abuse at the University Hospital of Northern Norway. Data was drawn from electronic patient journals.Results: A total of 286 mothers and 136 fathers participated in the study, and 46.3% were single parents. Parents had 1–7 children (M = 2.24; SD = 1.02). Most parents had one diagnosis (n = 311, 73.7%), and mood disorders was the most frequent type of diagnosis. The largest proportion of parents had serious mental disorders (n = 185; 46.0%), and a large proportion of the sample was affected by disorders of moderate severity (n = 156; 38.8%). The mean age of the children was 8.6 years (SD = 4.97), and 432 children (74.6%) had one or more siblings. The large majority of children had access to adult resource persons other than the mentally ill parent (n = 424; 94%), but 6% of the children (n = 27) did not. About three quarters of the children (76.2%, n = 526) were living with the mentally ill parent (n = 401), and 170 children (32.5%) lived with a single parent with a mental health disorder and siblings, full time or part of the time. The odds that parents had informed their children about the treatment/hospitalization and condition was higher the older the child was (p < 0.001), and the youngest children rarely got necessary information about this.Discussion: Risk and protective factors associated with the children's ages, access to resource persons, information about the parent's health problems and treatment are discussed in relation to different preventive steps for COPMI.

Background: Children of parents with mental disorders are more likely to develop mental difficulties during their childhood and adulthood. Based on this knowledge, the Norwegian health legislation has been amended to better identify and protect children of parents with a mental illness. In this project, two interventions were implemented in a regional clinic for adult mental health services. These interventions were (i) Assessment Form and (ii) Child Talks. Both interventions aimed to support healthcare professionals in identifying and providing support for children of patients within adult mental health services. The process of changing relevant practice to become more family-focused was evaluated in 2010 and 2013, and the results showed some changes slowly materializing in the adult mental health services. The purpose of the current study was to investigate long-term effects of the interventions at 5 year follow-up (2015). The main aim was to investigate whether the workforce perceived that their clinical practice had changed as a result of the legislative change and the implemented interventions.Method: This longitudinal study consists of a pre-test, post-test and follow-up test. The sample (N = 219 at pre-test, N = 185 by post-test and N = 108 on follow-up test) included healthcare staff from a participating hospital, responding to an online survey about their routines for identifying children of patients, their attitudes, as well as concerns and expectations related to having a child perspective in their clinical work. Employee experiences with family conversations were also investigated, as well as their knowledge about the consequences parents' mental disorders may have for children.Results: Our findings showed a significant increase in participants identifying children of patients between pre- and post-measurement but a minor, non-significant increase at follow-up measurement. There was no significant increase of participants who reported that they had a lot of experience with family conversations. From post-test to follow-up, there was no increase in the workforce' reported positive attitudes, knowledge or expectations about the effects of the interventions.Conclusion: There have been some changes in clinical practice, but it seems that the changes required by law are a very time consuming process. It is necessary to increase the pace of the implementation process.