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Children exposed to the risk factors associated with parental mental illness are seen to be at risk of developing cognitive, emotional, and behavioural difficulties in preschool and later in life. Given that educational settings are seen as optimal for early intervention, preschool teachers have an important role to play in identifying and responding to the needs of these vulnerable children at a critical period of their development. The aim of this study was to explore the experiences of preschool teachers who have taught, or currently teach, preschool aged children (4-6 years) affected by a parent's mental illness. Seven university qualified preschool teachers were interviewed about their experiences and reflected on their practices, specifically those practices that seemed to help support the child and those that did not. The findings highlighted that preschool teachers are knowledgeable and have the skills to identify warning signs and risk factors for young children, however this knowledge was limited in the context of parental mental illness and associated risks for preschool children. As such, the present study highlighted the need for targeted and specialized training and resources designed for the needs of preschool teachers. Several implications were discussed.

Introduction: Caesarean scar pregnancy (CSP), if not managed timely, can result in pre‐term labour, postpartum haemorrhage, hysterectomy or maternal and fetal death. This study aims to compare the diagnostic performances of different sonographic features recommended in various good practice recommendations and literature; then propose an algorithm that could aid in easier identification of CSP using transvaginal ultrasound. Methods: A retrospective review of ultrasound images of intrauterine pregnancy (IUP) and CSP between 4.9 and 11.9 weeks gestation was conducted. The diagnostic performance of the Royal College of Obstetricians & Gynaecologists (RCOG) guideline, Timor‐Tritsch et al. (TT) method and combined method were evaluated. An algorithm was then created to calculate a numerical value for diagnosis. The methods were tested for intra‐ and inter‐observer agreement. Results: A total of 66 ultrasound cases (30 IUP and 36 CSP) were included in this study. The sensitivity of the RCOG guideline, TT method and combined method were 58.3%, 94.4% and 100% while the specificity were 96.7%, 90% and 90%, respectively. The TT method and combined method performed significantly better than the RCOG guideline (p =.0016 and.0002, respectively). Using the proposed algorithm, a value larger or equal to 52.2 gave 97.2% sensitivity and 93.3% specificity that CSP is present. Intra‐ and inter‐observer agreement for all methods were moderate to almost perfect. Conclusion: Screening during early first trimester is important to improve the diagnostic accuracy of CSP. The TT method is a good supplement to the RCOG guideline. The proposed algorithm is a useful tool to improve diagnostic accuracy and confidence. [ABSTRACT FROM AUTHOR]

Objective Method Results Discussion This study aimed to investigate the benefits and difficulties with providing online peer support services for children with a family member experiencing mental health challenges.Using a qualitative descriptive design, the perspectives were gathered of Australian children and young people with a family member experiencing mental health challenges and had participated in online peer support activities during the COVID-19 restrictions of 2020 and 2021. Five age-differentiated focus groups were held with participants aged between 8 and 24 years (N = 32), and interviews were held with youth peer leaders (N = 3) and program facilitators (N = 6).This paper presents seven themes generated from the qualitative data. The themes captured the benefits of an online setting such as enabling greater accessibility, participation and comfort. Juxtaposed with this, themes also captured challenges such as the unease and risks of participating online, as well as the perspective that in-person activities facilitated stronger and quicker connections.It was concluded that a blended model of online and in-person support services is likely to be valuable for children with a family member experiencing mental health challenges to ensure accessibility and provide the capacity to meet the varied needs of this cohort. [ABSTRACT FROM AUTHOR]

Early interventions for children whose parents have a mental illness, comprising the provision of age-appropriate information about mental health, positive coping strategies, and meaningful social and emotional connections, are identified as preventive interventions for childhood health and wellbeing. The aim of this study was to evaluate the CHAMPS (Children and Mentally Ill Parents) peer support program that is designed to connect, support and educate this cohort of children and their parents/carers. The CHAMPS program was reviewed and co-designed by clinicians, parent participants, peer workers and children in 2017 and 2019. The revised modularised program incorporates peer facilitators and shared lived experience as a way for participants to build understanding of their own experiences and strategies for coping. Children, parent/carers and program facilitators were interviewed for this study. This paper presents findings from interviews conducted with 8- to 12-year-old children (N = 20) who completed CHAMPS; parents/carers (N = 17) and program facilitators (N = 10). Children reported that the program lessened isolation and feelings of self-blame for their parents' struggles; and parents reported benefits from supported communication with their children in explaining their diagnosis and in understanding the needs of their child. It was concluded that early intervention peer support programs for children can have multiple positive impacts on the family, highlighting the importance of psychoeducation and improved family communication, as well as connections to peers for supporting families where parents have a mental illness. [ABSTRACT FROM AUTHOR]

Forms of collaborative knowledge production, such as community‐academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6‐month co‐design process, during which 26 community‐ and 13 research‐partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community‐partners reflected on the activities which took place during the co‐design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community‐ and eight research‐partners revised the results and co‐authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well‐structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co‐designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co‐design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co‐writing with community‐partners results in a better research output and benefits for participants. [ABSTRACT FROM AUTHOR]

This article reports a strengths-based intervention to support parents with mental illness and their children in adult mental health settings: "Let's Talk About Children" (LTC) intervention. A qualitative methodology was adopted with parent participants receiving LTC in adult mental health and family services. The benefits for parents receiving LTC were described through in-depth interviews with 25 parents following the delivery of the program. Interview data identified an impact on parental self-regulation—mainly through a change in a sense of agency as a parent—and skill building, once a clearer picture of their child's everyday life was understood. This study outlines the benefits of talking with parents about the strengths and vulnerabilities of their children during routine mental health treatment. The role for self-determination of parents in preventive interventions for children is an important consideration for mental health recovery, and it also helps to break the cycle of transgenerational mental illness within families. [ABSTRACT FROM AUTHOR]

Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent's illness on children. Notwithstanding the availability of several evidence‐based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change. [ABSTRACT FROM AUTHOR]

Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria. [ABSTRACT FROM AUTHOR]

Background: Translating evidence-based practice to routine care is known to take significant time and effort. While many evidenced-based family-focused practices have been developed and piloted in the last 30 years, there is little evidence of sustained practice in Adult Mental Health Services. Moreover, many barriers have been identified at both the practitioner and organizational level, however sustainability of practice change is little understood. What is clear, is that sustained use of a new practice is dependent on more than individual practitioners' practice. Design and Method: Drawing on research on sustaining Let's Talk about Children in adult mental health services and in the field of implementation science, this article proposes a model for sustaining family focused practice in adult mental health services. Sustainability Model for Family-Focused Practice: An operational model developed from key elements for sustaining Let's Talk about Children identifies six action points for Adult Mental Health Services and their contexts to support the sustainability of family-focused practices. The model aims to support Services to take action in the complexity of real-world sustainability, providing action points for engaging with service users and practitioners, aligning intra-organizational activities, and the wider context. Conclusion: The model for sustaining family-focused practice draws attention to the importance of sustainability in this field. It provides a practical framework for program developers, implementers, adult mental health services and policy-makers to consider both the components that support the sustainability and their interconnection. The model could be built on to develop implementation guides and measures to support its application. [ABSTRACT FROM AUTHOR]

Trauma is a factor impacting the lives of many people experiencing psychiatric disorders. Trauma affects people's responses to illness as well as their interactions with services. This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care. An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists. Four themes were identified: Making sense of trauma; A contentious relationship between trauma and mental illness; Treatment made more challenging by trauma; Trauma-Informed Care highlights tensions. Psychiatrists are familiar with the concept of trauma but there are differences in beliefs about its relationship to mental illness that are consequential for practice. Trauma-Informed Care is seen as an effort to humanise mental health services, but with perceived limited impact on psychiatrists' roles. Findings indicate need for further consultation and collaboration with psychiatrists around trauma-informed care implementation; as well as consideration of what is required to develop professional consensus on trauma and its relationship to illness. [ABSTRACT FROM AUTHOR]

Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts. Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study. Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem. Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice. [ABSTRACT FROM AUTHOR]

Sustainability is a desired outcome of implementation. Understanding how organizations support new practices after implementation is important for sustainability. Let's Talk about Children (hereby referred to as 'Let's Talk'), a family‐focused intervention with parents with a mental illness, improves family, parent, and child outcomes. Little is understood about how organizations support sustained practice. The study aimed to (i) understand the implementation process that occurred in eight adult mental health services during a previous randomized controlled trial; (ii) establish their continued capacity to embed Let's Talk; and (iii) explore links between organizational capacity and sustained delivery by practitioners. This mixed method study used a questionnaire and individual interviews to collect data on the implementation process and current organizational capacity to support Let's Talk 12months after the randomized controlled trial. Links between organizational capacity and the adult mental health services with practitioners' continuing to use Let's Talk in the past 12 months were explored. Services with higher current organizational capacity scores had practitioners currently delivering Let's Talk. These services had all made changes to their organizational structures to support Let's Talk practice. All services experienced significant changes during and after implementation, influencing sustainability of Let's Talk. Addressing organizational capacity appears to be important to enable sustainability of Let's Talk implementation endeavours. Real‐world settings are constantly changing systems requiring ongoing tracking and adjustments to understand and support sustainability. Internal service development staff appear to support the shaping of organizational capacity to support Let's Talk; however, broader organizational support is needed for change within a complex system. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Family‐focused interventions in Adult Mental Health Services (AMHS) address the needs of families where a parent is diagnosed with a mental illness. One of these interventions is the "Let's Talk about Children" programme (Let's Talk) (Solantaus & Toikka, 2006 International Journal of Mental Health Promotion, 8(3), 37).There is limited implementation knowledge on family‐focused interventions.A body of research to better understand the transfer of evidence‐based interventions into everyday practice has identified multiple influencing elements. The Consolidated Framework for Implementation Research (CFIR) has combined these known elements from research into five domains of influence.Elements that influence the implementation of evidence‐based practice are inter‐related and need to be understood in combination.Understanding different stakeholder perspectives on implementation in real‐world settings helps to understand uptake, challenges and opportunities. What the paper adds to existing knowledge?: As the first study to document leadership's perspectives of implementing Let's Talk, this paper contributes to the evidence base on their role in implementing family‐focused practice models in mental health.There are specific roles of leadership that need to be addressed to support implementing Let's Talk in changing environments.Leadership's knowledge of Let's Talk and approach to change influences implementation.Questions are raised about the role the readiness of the parent and the impact that the dynamic process between the practitioner and parent has on implementing Let's Talk. What are the implications for practice?: Engaging leadership needs to address the influence of their different organizational roles in shaping implementation for Let's Talk.Further research is needed to understand the dynamic process between parent and practitioner that influences readiness for trialling Let's Talk. Introduction: Different stakeholder's perspectives are needed to understand challenges and opportunities in implementing and sustaining evidence‐based practices (EBP) in real‐world settings. Aim/Question: To identify leadership perspectives on key elements influencing the process of implementation of Let's Talk about Children (Let's Talk), a family‐focused practice for practitioners working with parents diagnosed with a mental illness. Method: Semi‐structured interviews were conducted with 16 service managers and implementation leads, to establish their views on key elements influencing implementation of Let's Talk during a randomized controlled trial. A thematic analysis applied both inductive and deductive approaches, using the Consolidated Framework for Implementation Research (CFIR). Results: Impacts to effective translation to practice were grouped into three broad themes with eight subthemes: inner and outer setting impacting organization, leadership affecting readiness and parent and practitioner readiness. Discussion: The findings suggest that specific roles for leadership are vital to implementation within an environment of constant change, and more attention is needed to understand the dynamics of parent and practitioner readiness for delivering Let's Talk. Implications for practice: Different leadership roles need to be engaged to sustain Let's Talk in changing real‐world environments. The dynamic processes between parent and practitioner are suggested to influence readiness and need further research. [ABSTRACT FROM AUTHOR]

Family‐focused interventions can improve outcomes for families where a parent has a mental illness. One such intervention, Let's Talk about Children (Let's Talk), is a series of parent–practitioner conversations in adult mental health with demonstrated improved outcomes for child, parent, and family well‐being. This study used a questionnaire to understand the application of Let's Talk by n = 73 trained practitioners from eight adult mental health services who were previously involved in a randomized controlled study in Victoria, Australia. Data were analysed to establish the application of Let's Talk, and statistical analyses were undertaken to identify what influenced practitioners' delivery of Let's Talk. The study details how practitioners used Let's Talk and indicates that most used it as designed, with the majority offering it to parents and approximately 40% delivering it. The findings indicate there is a decline over time in both the number of practitioners using Let's Talk and the number of deliveries over time. Practitioners' use of Let's Talk was influenced by their gender, profession, access to support, time since training, and caseload. The article discusses the implications of these results for sustaining Let's Talk in adult mental health services. While this study gives a baseline of practitioners' application of Let's Talk, further exploration of the experience of practitioners and parents as well as other system factors will be helpful to understand barriers and enablers to continued practice. [ABSTRACT FROM AUTHOR]

Training health workers in research skills equips them to be instrumental in the development and implementation of evidence-based practices that reflect contemporary health service delivery. Research training seeks to develop health worker knowledge, skills and behaviour in practice research and evidence and where possible to develop an evidence focused organisational culture. Social work professionals are critical contributors to practice-based evidence development, particularly in delivering effective practice strategies within complex health and mental health settings. Termed "Smart Skills", the training aimed to increase the evidence base for health and mental health programs and practices related to Australian children, parents and/or families through training and mentorship. [Extracted from the article]

Objective: This paper describes a Training and Mentoring Program, designed to enhance research capacity for social workers based in community and inpatient settings in Australia. Method: Twenty-one social workers participated in the multiday training and follow-up mentoring program (small group and individual) over a 24-month period. Outlined is a mixed-method quasi-experimental evaluation of the approach. Results: Quantitative data showed an increase in self-reported research capacity including knowledge, confidence, behaviour and satisfaction. The mentoring approach appeared to be a crucial component for participants – for their engagement with research, willingness or ability to bypass perceived and real hurdles, and completion of an individual research project. A significant barrier to research was a lack of available research time during their clinical role and forcing participants to complete research projects in their own time. Additionally, personal challenges such as health and family commitments on time available to undertake research after hours impacted on engagement and research project completion. Discussion: Social workers are critical contributors to practice-based evidence development in health and mental health settings. However, many report a lack of knowledge, confidence and skills in service evaluation and research. The findings demonstrate that social workers are keen to take on practitioner-research roles, that research capacity is enhanced through training particularly with follow-up mentoring to support individual research project development and implementation, and that large system changes need to occur to support social workers to engage in research activities in their work context. [ABSTRACT FROM AUTHOR]

Let's Talk About Children is a manualised intervention for parents with a mental illness that aims to impact positively on family dynamics. Previous evaluations focused on parents with an affective disorder. The purpose of this study was to evaluate the intervention for parents with various mental illnesses and explore parents' self-reported views regarding the impact of the intervention. A quasi-experimental approach was employed to compare outcomes for parents who received Let's Talk About Children plus treatment as usual (n = 20) with a wait list control (treatment as usual) group (n = 19), using family functioning and parenting stress questionnaires. Questionnaires were completed 2 weeks prior to receiving the intervention and 4 to 6 weeks after the final session. The wait list parents completed the same questionnaires at two time periods, 6 weeks apart. Semi-structured interviews were conducted after the intervention. Both intervention and control groups showed improvements in parenting and family functioning. Interview data highlighted (1) increased insight, (2) normalising of the illness in the family, (3) family communication changes, (4) the importance of supporting the parenting role and (5) suggestions for additional supports. There are possible issues regarding the influence of psycho-education when giving participants information about the nature of the research. [ABSTRACT FROM AUTHOR]

Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6‐month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education‐related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted. [ABSTRACT FROM AUTHOR]

The issues that confront families when a parent experiences mental illness are complex. This often means that multiple service systems must be engaged to meet families' needs, including those related to intergenerational experiences of mental health and illness. A multisystem approach to public mental health care is widely recommended as a form of preventative intervention to address the effects of mental illness and its social, psychological, and economic impact upon parents, children, and families. Globally, a multisystemic approach to care requires a change in the way systems are currently organized to support families, as well as the way systems are interacting with families, and with each other. This qualitative secondary analysis emerged from a primary study examining global systems change efforts to support families, including components of change that were common and considered successful in different countries. A narrative inquiry method was used to re-analyze the data by compiling the stories of change described by individuals from participant countries. The data were interrogated to ask questions about story content, and to identify who was telling the story and how they described important changes across different geographical and cultural contexts. The individual stories of 89 systems change experts from 16 countries were then compiled into a shared global narrative to demonstrate international progress that has occurred over time, toward multisystemic change to support families where parents experience mental illness. While the global narrative demonstrates considerable overlap between pathways toward change, it is also important to document individual stories, as change pertains differently in different contexts. The individual stories and the global narrative illustrate how countries begin a journey toward change at different time points and may have various outcomes in mind when they commence. Study findings raise questions about the extent to which systems change can be standardized across countries that have unique social, cultural, political, and economic features. This study provides several potential points of reference for countries considering, or currently undertaking systems change to support families where a parent has a mental illness. It also provides an important story about international efforts undertaken to improve outcomes for families. [ABSTRACT FROM AUTHOR]