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Background: 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., Aim: This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care., Methods: An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists., Results: 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., Conclusion: 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.

Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are passed across generations without exposure to the original event. This qualitative study aimed to explore how psychiatrists understand intergenerational trauma in respect to their practice, for the purposes of identifying interventions for addressing intergenerational trauma in public mental health services. Findings revealed that psychiatrists observe intergenerational trauma frequently in their roles and try to opportunistically promote awareness of trauma with adults, and refer families to external services for supportive interventions. They feel powerless when faced with directly intervening with intergenerational trauma and required restructuring of their roles to adequately address it in public settings. Findings have implications for training, advocacy and research on the relationship between trauma and mental illness. Alongside this, there is an indicated need for examination of how systems can ensure access to appropriate services once organisations become trauma-informed.

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., (© 2020 Australian College of Mental Health Nurses Inc.)

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. ABSTRACT: 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., (© 2020 John Wiley & Sons Ltd.)

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., (© 2020 Australian College of Mental Health Nurses Inc.)

Background: 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., Method: A purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews., Results: 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., Conclusion: 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., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Children who grow up with a parent who has a mental health problem (25%) are at increased risk of developing (health) problems themselves. One approach to reach those children for early intervention supports is through their parents seeking treatment within the adult mental healthcare system. We aimed to gain information on the users of adult mental health services in Tyrol, Austria in order to understand more about the identification of these families to provide support., Methods: We descriptively analysed administrative claims data from the Tyrolean health insurance. Uptake of mental health services (hospital inpatient and day-care services, rehabilitation, outpatient psychiatrist and psychotherapy services), prescription medication and sick leave in persons aged 19-64 in 2017 were analysed., Results: The vast majority (82%) of an overall number of 49,494 patients were prescribed medication for their mental health issues. Half of them only received medication as their form of treatment. A quarter had contacted an outpatient psychiatrist and 13% received psychotherapy. Five percent were treated in psychiatric inpatient or day-care. The median length of hospital stay was 15 days. More women than men used mental health benefits., Conclusions: Most parents may be reached via the general practitioner (via drug prescriptions) and low numbers were found accessing services in a psychiatric hospital. The latter may, however, have higher needs for support given their greater acuity of illness. How to get into contact with their children requires thoughtful and sensitive preparation, given the stigmatisation of accessing support for mental health issues. Administrative data are a useful source for planning such early intervention strategies.

Background: A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context., Methods: We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate., Results: We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children's needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs., Conclusions: The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.

Nearly 50% of all mental illnesses begin in childhood before the age of 14 years, and over 20% of parents have a mental illness. Few studies have examined the co-occurrence of mental illnesses in parents and children. In the present study, we examined the extent of mental illness within families of 152 clients attending an Australian regional child and adolescent mental health service (CAMHS). A cross-sectional study design was employed involving a case record review and clinician-completed questionnaire of the children and youth attending a CAMHS. It was found that 79% of these children were living with a parent with mental illness. The predominant diagnosis of both child and parent was an anxiety or mood disorder, and many families had co-occurring risk factors of domestic violence and limited social supports. The findings in this Australian cohort are similar to those of other international research. While novel in nature, the present study has highlighted the extent of both mental illness and scarce supports for both children and parents in the same family. The findings indicate the need for a coordinated multiservice delivery of appropriate and consistent family-focussed interventions, responding to both mental illness and social supports for children and parents. Further research should examine specific components of family need and support, as seen through the eyes of the child and their parent., (© 2017 Australian College of Mental Health Nurses Inc.)

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., (Copyright © 2015 Elsevier Inc. All rights reserved.)

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., (© 2014 Family Process Institute.)

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., (© 2012. Published by Elsevier Inc. All rights reserved.)

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]

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]

Background: While effective interventions have been developed to support families where a parent has a mental illness in Adult Mental Health Services, embedding and sustaining them is challenging resulting in families not having access to support. This study developed an explanatory model of influencers that had enabled sustainability of the Let's Talk intervention in one service. Methods: A participatory case study was used to build an explanatory model of sustainability at the service using theoretical frameworks. Qualitative and quantitative data was collected about practitioner's practice and the organisation's implementation process and capacity to support practice. A local research group worked with the researcher using a transforming data approach through description, analysis and interpretation. Results: Influencers were grouped into four major categories: (1) External social, political and financial context, (2) Resources, (3) Prior organisational capacity and (4) Sustainability Factors. The last category, Sustainability factors, was divided into three subcategories: (4.1)Practitioner (4.2) Organisation and (4.3) Parent-Client. These categories form part of an explanatory model for the key influencers of continued practitioner practice and organisational capacity to support practice. Conclusions and implications for practice: In this case study, the pre-existing organisational context along with practitioner, organisation and parent-client factors operated together to influence sustainability. The results suggest that sustainability is more likely to be supported by both linking Let's Talk to existing organisational identity, capacity, structures and relationships and by supporting mutual adaptations to improve the fit. Additionally, by understanding that setbacks are common and ongoing adjustments are needed, implementers are able to have realistic expectations of sustainability. [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]

This paper provides a framework for essential family‐focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses' and other clinicians' capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence‐informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care. [ABSTRACT FROM AUTHOR]

Family‐focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family‐focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family‐focused behaviours and other factors that impact family‐focused activities. Hierarchical multiple regression identified 14 predictors of family‐focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family‐focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses' personal characteristics and work setting are key factors in determining family‐focused practice. This study extends current research by clearly highlighting predictors of family‐focused practice and reporting how various enablers promoted family‐focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere. [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]

Parenting with mental illness is not uncommon and is often associated with a range of challenges for parents, children, and the family unit. Family-focussed practice involves the provision of services to the wider family system, including children. While family-focussed practice is important to consumers and their families, adult mental health practitioners do not routinely discuss parenting or children with their clients, nor work closely with the whole family. In the present study, we aimed to examine the characteristics of practitioners from Australian adult mental health services associated with family-focussed practices. Characteristics included sex, years of experience, location, and previous training in child and family-focussed practice. A total of 307 adult mental health practitioners from Victoria, Australia, responded to the Family Focused Mental Health Practice Questionnaire and a series of demographic items. The results indicated that particular practitioner characteristics predicted the delivery of family-focussed practice. Practitioner experience, sex, working in a rural location, and previous family- or child-related training were found to be important in the provision of family-focussed practice. More experienced, female, rurally-located, and well-trained practitioners undertake most family-focussed practice. These results suggest that training in family-focussed practice needs to be promoted, with considerations made for differing needs according to the characteristics of the adult mental health practitioner. [ABSTRACT FROM AUTHOR]

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. [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]

A collaborative approach to care of parents with a mental illness is essential to address the needs of the whole family. However, a number of constraints within adult mental health and child-focused services prevent a unified approach to the care of families where a parent has a mental illness (FaPMI). This paper reports on a cross-sector workforce development initiative aimed to build skill and knowledge in practitioners to work with FaPMI. The initiative included training in the 'Keeping Families and Children in Mind' e-resource to mental health, child and family services. The resource was combined with face to face training and small group meetings over six weeks, to help develop emerging champions/practice leaders to promote FaPMI-focused practice. A significant decline in the perceived ability to engage in FaPMI-focused practice emerged immediately post-training. The lack of perceived organisational supports was the major barrier to the implementation of FaPMIfocused practice across sectors. However following continued support of practitioners, a significant increase in FaPMI-focused practice across sectors, and a return to pre-survey levels of perceived organizational support, was observed at six-month post-training. The importance of providing additional implementation supports and time to consolidate practice change following training is highlighted. Recommended implementation and training strategies that will improve FaPMI-focused cross-sector approaches to better meet the need of FaPMI are described. [ABSTRACT FROM AUTHOR]

While many people with a mental illness care for young children, there is a paucity of resources for these families and the professionals working with them. The purpose of this paper is to describe a new online resource, Pathways of Care, specifically designed for parents with a mental illness, early childhood educators, and mental health workers, and report on a pilot evaluation of the resource. Using a mixed method design, the effectiveness of the online resource in effecting worker confidence, knowledge and family-focused practice change will be examined. Pathways of Care aims to promote collaborative practice between agencies, identify relevant agencies and support workers in talking to parents about mental illness in families. Fifteen workers completed the Family Focus Mental Health Practice Questionnaire pre- and post-viewing the resource, to measure confidence and practice change; semistructured interviews were then conducted with eight of these same workers to further explore the utility of the resource. Findings tentatively indicate that the resource was effective in increasing worker knowledge and confidence. This study highlights the importance of the development and provision of resources, such as the Pathways of Care, to promote collaboration between service providers in the early childhood and mental health sectors working with families with young children. [ABSTRACT FROM AUTHOR]

This article outlines the development of practice standards for the adult mental health workforce for addressing the needs of families where a parent has a mental illness (FaPMI). The practice standards recommended here were formulated using a modified cooperative inquiry process with a group of senior clinical leaders in adult mental health services in Australia, following consultation with the available literature and policy documents. The aim of the project was to generate, align, and operationalize family-inclusive practice standards within the core activities of the adult mental health workforce and integrate into the continuum of care and recovery for service users who are parents of dependent children. As part of a modified Delphi method, the standards were also ranked by the senior clinical leaders to determine what they believe to be essential and recommended practices for the adult mental health workforce they manage. We argue that developing practice standards that provide practical and realistic expectations of the adult mental health service workforce enable services and workers to better adapt practice to respond to FaPMI. [ABSTRACT FROM AUTHOR]

Objective: To identify the key goals that are established by children and parents from families in which parents have substance use and/or mental health problems, and the level of progress achieved towards goals over 1 year of case management. Design, setting and participants: Participants from three rural sites of a New South Wales non‐government agency completed family care plans between 2008 and 2010. They included 44 parents and 41 children from 37 families where at least one parent had a dual diagnosis or mental illness. Family care plans were analysed to identify the frequency and progress of child and parent goals across 11 domains. Main outcome measures: Goals identified by parents and children, and change scores over a 12‐month period. Results: Children most frequently set goals to enhance their knowledge of mental illness, schooling, family connectedness and interpersonal skills. Parents most frequently set goals to improve their knowledge of mental health. Children recorded greatest goal achievement: in enhancing their mental health knowledge, community/social connectedness and accommodation needs. Parents recorded most goal progress in understanding developmental milestones of their children. Conclusions: Goal setting appears to be an important mechanism for assisting families with complex needs. Clinicians need to address the mental health literacy of families where a parent has a substance use problem and/or mental illness. [ABSTRACT FROM AUTHOR]