Search

Objectives: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2022. Published by Elsevier Inc.)

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., (© 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Background: A considerable number of people with a mental illness are parents caring for dependent children. For those with a mental illness, parenting can provide a sense of competence, belonging, identity and hope and hence is well aligned to the concept of personal recovery. However, little research has focused on the recovery journey of those who are parents and have a mental illness. This randomised controlled trial aims to (i) evaluate the effectiveness of an intervention model of recovery for parents (Let's Talk about Children) in three different mental health service sectors and (ii) examine the economic value of a larger roll out (longer term) of the parent recovery model., Methods: A two arm parallel randomised controlled trial will be used with participants, who are being treated for their mental illness in adult mental health, non-government community mental health or family welfare services. The study will involve 192 parents, who are considered by their treating practitioner to be sufficiently well to provide informed consent and participate in an intervention (Let's Talk about Children) or control group (treatment as usual). Participant randomisation will occur at the level of the treating practitioner and will be based on whether the randomised practitioner is trained in the intervention. Outcomes are compared at pre, post intervention and six-month follow-up. Recovery, parenting and family functioning, and quality of life questionnaires will be used to measure parent wellbeing and the economic benefits of the intervention., Discussion: This is the first randomised controlled trial to investigate the efficacy of a parenting intervention on recovery outcomes and the first to provide an economic evaluation of an intervention for parents with a mental illness. An implementation model is required to embed the intervention in different sectors., Trial Registration: The trial was retrospectively registered: ACTRN12616000460404 on the 8/4/2016.

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]

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]

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]

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]

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]

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]

Understanding of key characteristics and processes of personal recovery from mental illness is growing. However, a paucity of research exists with mothers with mental illness around experiences of personal recovery. An improved understanding of the interplay between illness, parenting and broader social factors may better inform how mental health services respond to the needs of these women. Using constructivist grounded theory (CGT), in-depth interviews were conducted with seventeen women who were mothers with a mental illness, residing in Australia. Through the CGT technique of constant comparative analysis, initial codes were synthesised and theoretical sampling employed to reach saturation of the categories associated with the construct of personal recovery. For mothers with a mental illness, personal recovery takes place within and is shaped by broader social contexts. Six key dimensions of personal recovery were ‘recognising recovery’, ‘mothering’, ‘experiencing oppression’, ‘managing distress’, ‘making a change’ and ‘feeling better’. This study found that mothers with mental illness interpret recovery as enduring through difficult times, rather than a process of personal transformation and adjustment which is articulated within personal recovery literature. Well-being outcomes for women with children may be more effectively promoted through strategies that address underlying factors such as supporting early mothering, preventing violence against women, addressing trauma, and redressing socio-economic disadvantage and gender disparity. [ABSTRACT FROM AUTHOR]

This paper acknowledges progress over the last 20 years in addressing intergenerational risks to the mental health of children whose parents experience mental illness (COPMI-Children of Parents with a Mental Illness and FaPMI-Families Where a Parent Has a Mental Illness) and emphasises ongoing challenges to implement evidence informed family focused interventions. Challenges include variability in practice at individual, regional, and cross-national service system levels and the gap between implementation science and practice. This article begins to address this gap with descriptions of key systems approaches and implementation strategies from around the world to illustrate variability and common themes. A multifaceted, integrated systems approach is proposed as a way forward. Learnings and experience from initiatives, expertise and evidence targeting other vulnerable groups and successful change implementation will enhance existing (COPMI/FaPMI) efforts to facilitate systems change and improve the lives and futures of these children and families around the world. [ABSTRACT FROM AUTHOR]

Summary This study explores the concept of family resilience where a parent has a mental illness. Eleven Australian adults who have grown up in a household with a parent who had a diagnosed mental illness participated in an in-depth interview. The interviews focused on the ways in which these families responded to challenges in everyday life, particularly related to parental mental illness. Findings Families developed resilience through processes such as shared humour or regular family rituals and routines. In some cases, open communication about mental illness enabled families to better cope when parents were unwell and to build a greater sense of family connectedness. However, data suggest that parental mental illness potentially creates stress and confusion for families and there are multiple social and cultural barriers that make it difficult for families to acknowledge and speak openly about mental illness. For participants, resilience tended to be about maintaining a balance between stress/distress and optimism and strength within their family. Applications The article highlights the importance of family context when describing resilience, and identifies specific clinical implications for working with families affected by parental mental illness. [ABSTRACT FROM AUTHOR]

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross-sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices. [ABSTRACT FROM AUTHOR]

Background: The perspective of children whose parents have a mental health and a substance use disorder (dual diagnosis) are rarely considered in either research or clinical practice. This study sought to (i) identify the issues when engaging children whose parents have a dual diagnosis into research, and (ii) present their needs and preferred supports. Method: Semi-structured, qualitative interviews were conducted with 12 children whose parent had a dual diagnosis. Analyses involved thematic analysis, inter-rater reliability and respondent validation. Results: Building trust with parents was crucial to gain access to children. Children described the importance of family, the secrecy around their parent's substance abuse, and various maladaptive coping strategies. Children requested more positive times in their families and specific support for their parent's substance abuse. Conclusion: The primacy of family in the child's life is highlighted. The need to acknowledge and work with the individual needs of children and parents, as well as family dynamics, is indicated. [ABSTRACT FROM AUTHOR]

Having a parent with a mental illness can create considerable risks in the mental health and wellbeing of children. While intervention programs have been used effectively to reduce children's psychopathology, particularly those whose parents have a specific diagnosis, little is known about the effectiveness of these early interventions for the wellbeing of children of parents who have a mental illness from a broad range of parents. Here we report on an evaluation of CHAMPS (Children And Mentally ill ParentS), a pilot intervention program offered in two formats (school holiday and after school peer support programs) to children aged 8-12 whose parents have a mental illness. The wellbeing of 69 children was evaluated at the beginning of the programs and four weeks after program completion, on instruments examining self-esteem, coping skills, connections (total, within and outside the family) and relationship problems (total, within and outside the family). Post intervention, there were significant improvements in self-esteem, coping and connections within the family, and reductions in relationship problems. The impact on children's wellbeing differed according to the intensity of the program (consecutive days or weekly program). The results are discussed in the context of providing interventions for children whose parents have a mental illness and the implications for service provision generally. [ABSTRACT FROM AUTHOR]

The aim of this study was to review the child, parent and family programs and workforce initiatives in Australia that target children and families where a parent has a mental illness. Fifty two individual telephone interviews were conducted with facilitators responsible for 60 child, parent, family and workforce programs across Australia. Interviewees were asked to describe (i) the program provided, (ii) the evidence framework of the program, and (iii) evaluation strategies employed. To supplement this data, three consumers and one carer were interviewed regarding their involvement in programs. Participants were identified through websites, e-discussion lists and snowball recruiting. Audio transcripts from the interviews were qualitatively analysed, using thematic analysis, alongside inter-rater reliability and member checks. Of the 60 identified programs, there were 26 child and adolescent programs, six programs for parents with a mental illness, four family programs and 24 workforce training initiatives. Program facilitators typically drew on their clinical experiences, rather than research, when developing programs. Generally, evaluation strategies were non standardised and/or measured participant satisfaction of programs. There was no systematic way of involving and supporting consumers and carers. Recommendations are made regarding evaluation training, a participation framework for consumers and carers, funding for programs, and the establishment of a formal network for sharing resources and facilitator experiences. [ABSTRACT FROM AUTHOR]

A growing number of studies over the past decade have identified the needs of families where a parent has a mental illness (FaPMI) and the responsibility of organisations to provide adequate services to effectively support them. This article describes the development and implementation of a cross-sector audit between mental health and family support services in a catchment area in Melbourne, Australia. The audit gathered information about the number, demographics, supports and potential needs of FaPMI clients and their dependent children (aged 0-18 years). Selected results are presented here. Across ten teams, the audit identified 223 FaPMI clients (including ten shared clients across organisations) with a total of 400 children. The audit provided insight into gaps in knowledge about FaPMI and possibilities for service development for participating agencies. [ABSTRACT FROM AUTHOR]

The article presents the results of a study on family care plans used for intervention programs in families with parental mental problems. It notes that the family care approach with its goal-setting mechanism is viewed as an important component of the recovery support for people with mental illness and offers significant benefits to the entire affected family. Results showed that goals set by children and parents centered respectively on improving mental illness and mental health literacy.