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The Family Model is increasingly used as a framework to promote a whole family approaches in mental health services. The purpose of this qualitative study was to (i) explore whether nurses practice in accordance with the Model when providing services for parents who have mental illness, (ii) determine whether components of the model are employed more in some workplaces (i.e. acute in-patient units versus community settings) and (iii) ascertain reasons as to why this may be the case. A purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews. Findings indicated that nurses' practice incorporated most key components of The Family Model, including supporting service users' dependent children. However, some practices were not explicit in the Model, such as supporting other adult family members (i.e. grandparents). While nurses' practice in community settings was more aligned with The Family Model than in acute in-patient units, there was a notable absence of reference to domain six (cultural considerations) in both settings. A holistic and family-centered philosophy, coupled with collegial and managerial support and a focus on prevention were the main features that enabled family focused practice in community settings. As only a subgroup of nurses practice in accordance with The Family Model, efforts are required by nurses, their organisations and the broader system to promote family focused practice. The Family Model may be a useful framework, with further refinement, for guiding nurses' practice. • Nurses' practice reflected components of The Family Model (TFM) to varying extents. • Practice in community settings was more aligned with TFM than in hospital settings. • TFM may be a useful framework for promoting a whole family approach in adult mental health services. • Supportive organisational cultures are required to enable FFP, especially in hospital settings. [ABSTRACT FROM AUTHOR]

The medullary pyramid compresses during the early phases of severe hydronephrosis and represents a promising ultrasound metric for the diagnosis and surveillance of PUJ obstruction. The aim of this study was to define the optimal cut-off value and utility of medullary pyramid thickness (MPT) associated with the need for pyeloplasty in infants being followed up for hydronephrosis. A retrospective review was performed over a five-year period to identify patients that were under surveillance for hydronephrosis during infancy and underwent a MAG3 to monitor the possible need for pyeloplasty. Ultrasound images were retrospectively reviewed to measure the MPT of the affected kidney in a blinded fashion. The primary outcome measure was subsequent requirement for pyeloplasty before three years of age. The Mann–Whitney U Test was used to determine statistically significant differences in the minimum MPT between the infant group requiring pyeloplasty and the non-operative group. Receiver operating characteristic analysis was performed to determine the optimal cut-off value associated with the requirement for pyeloplasty. A total of 63 patient cases were included, of which 45 underwent pyeloplasty (70%). A significant difference was found in the median MPT measurement between the pyeloplasty and non-operative groups (1.7 mm vs. 3.8 mm, p < 0.001). The optimal cut-off value of MPT associated with pyeloplasty was 3.4 mm. An MPT threshold of ≤3.4 mm conferred a sensitivity of 98%, specificity of 63%, positive predictive value of 86%, and negative predictive value of 92%. Thinning of the medullary pyramid is an important ultrasound sign of parenchymal deterioration in high-grade hydronephrosis. An optimal MPT cut-off value of ≤3.4 mm is associated with subsequent pyeloplasty in infants. MPT should be considered in future studies addressing the diagnosis and surveillance of PUJ obstruction. [Display omitted] [ABSTRACT FROM AUTHOR]

Psychiatric nurses' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses' family-focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family-focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family-focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy. [ABSTRACT FROM AUTHOR]

It is estimated that 1 in 5 children have a parent with a mental illness, and studies have shown that such children are more likely to develop mental health problems when compared with their peers. Research has demonstrated the benefits of mental health clinician family-sensitive practice to both parents and their children; however, a measure of clinician practice is not available. The psychometric properties of a questionnaire measuring family-focused practice in the psychiatric setting are reported here. There were 307 public adult mental health worker participants, predominantly from the nursing profession and working full time. Principal component analysis highlighted 14 subscales that summarize 49 items reflecting organizational and worker factors, such as skill/knowledge about the impact of parental mental illness on children and worker confidence. Subscales are discussed in relation to the literature and psychiatric policy. The measure appears a useful tool for evaluation, benchmarking for training and organizational improvement, and ultimately, for increasing quality services to parents, families, and particularly children associated with psychiatric services. [Copyright &y& Elsevier]

The nature of adverse effects of parental mental health problems and of the interventions to address them may require specific designs of economic evaluation studies. Nevertheless, methodological guidance is lacking. We aim to understand the broad spectrum of adverse effects from parental mental health problems in children and the economic consequences on an individual and societal level to navigate the design of economic evaluations in this field. We conducted a systematic literature search of empirical studies on children's adverse effects from parental mental illness. We clustered types of impact, identified individual and public cost consequences, and illustrated the results in an impact inventory. We found a wide variety of short- and long-term (mental) health impacts, impacts on social functioning and socioeconomic implications for the children individually, and adverse effects on the societal level. Consequently, public costs can occur in various public sectors (eg, healthcare, education), and individuals may have to pay costs privately. Existing evaluations in this field mostly follow standard methodological approaches (eg, cost-utility analysis using quality-adjusted life-years) and apply a short-time horizon. Our findings suggest applying a long-term time horizon (at least up to early adulthood), considering cost-consequence analysis and alternatives to health-related quality of life and quality-adjusted life-years as outcome measures, and capturing the full range of possible public and private costs. • Programs to prevent adverse effects of parental mental illness in children have shown benefits. Nevertheless, economic evaluations are scarce and methodologically challenging. • We provide an overview on the spectrum of adverse consequences of parental mental illness in children and society and give an orientation on how this knowledge may be translated into the design of an economic evaluation regarding perspective, study type, time horizon, and selection of costs and outcomes. • Economic evaluations of family-focused interventions when parents have a mental illness require careful design and possibly deviation from standard methods (eg, quality-adjusted life-years) to avoid decisions based on misleading cost-effectiveness results. [ABSTRACT FROM AUTHOR]

The prevalence of developmentally vulnerable children living with parental mental illness has been well documented, however due to stigmatised attitudes and prejudice these children may be ‘hidden’ and not identified as requiring additional assistance in early childhood settings. The aim of the present study was to explore the experiences and workforce needs of centre-based child care staff working with families living with parental mental illness. Eight staff (four child care workers and four child care directors) who worked in centre-based child care were interviewed using a semi-structured interviews. The data were analysed using an Interpretative Phenomenology Analysis framework. The findings of the present study highlighted four central themes: child development issues, tension around referral and worker anxiety, inadequate knowledge and training about parental mental illness and sensitivity when working with families. While these participants knowingly prioritized the importance of working with families in their daily work, they described feeling stressed and anxious about discussing referral options with these parents, and often worried about ‘making things worse’ for the child and the parent. The present study has contributed knowledge in regard to an important segment of the early childhood workforce; such information can inform the development of tailored professional training and resources that provide information about referral procedures and support programs for these families. [ABSTRACT FROM AUTHOR]

Universal parenting programs, which are preventative social services seeking to strengthen parent child relationships, are not as common as those targeting specific physical or behavioral conditions in children. They have been evaluated less frequently, and yet their focus on prevention rather than treatment can lead to long term social and economic gains. Parents Building Solutions (PBS) is a universal, group-work parenting program where a skilled facilitator uses a co-design methodology to develop the program's agenda and content with parents. A pilot, quasi experiemental pre-test post-test trial was conducted to determine the program's efficacy in fostering increases in parenting quality, confidence, self-efficacy, and parental understanding of child development, as well as improving the ability of parents to respond effectively to children's behavior. Attrition was also measured. Data was collected at three time points from 58 parents (baseline) in three regions in Melbourne, Australia. Statistically significant differences were seen for all measures, with large effect sizes. Attrition was low with 90% of participants completing the program. Using a co-design methodology as a way to engage and retain parents may be a critical factor in the success of PBS, however further research is needed to firmly establish efficacy. • Universal prevention and early intervention parenting programs are under researched. • Parenting programs often suffer from high attrition and low engagement. • Parents Building Solutions (PBS) uses co-design and strength-based approaches. • A 'real-world' program, PBS is responsive, flexible and reaches parents everyday. • Low attrition and strong engagement is attributed to the co-design methodology. [ABSTRACT FROM AUTHOR]