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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]

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]

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. [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]

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]

Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice. [ABSTRACT FROM AUTHOR]

Aim and objective: To synthesise and critically interpret literature of relevance to intervening in intergenerational transmission of relational trauma within parent–infant relationships. Background: Intergenerational trauma is a discrete process and form of psychological trauma transmitted within families and communities. Intergenerational trauma can be transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma. Design: Critical interpretive synthesis (CIS) was used. CIS is an inductive qualitative process that generates new theory grounded within reviewed literature. Methods: The review commenced by systematically searching for literature on interventions for intergenerational trauma. As the core theoretical construct emerged, elements that may contribute to preventing intergenerational trauma were identified iteratively and influenced further searching. In the final synthesis, 77 articles were included from the fields of intergenerational trauma, trauma interventions and attachment interventions. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist. Results: The key construct is that prevention of intergenerational trauma transmission is the key intervention. The two contributing constructs were identified as "resolving parental trauma" and "actively supporting parent–infant attachment." Conclusions: Prevention is the most effective intervention approach for intergenerational transmission of trauma. Prevention requires trauma‐specific interventions with adults and attachment‐focused interventions within families. Preventative strategies need to target individual, relationship, familial, community and societal levels, as addressing and preventing trauma requires a multipronged, multisystemic approach. Relevance to clinical practice: Systematic trauma‐informed attachment‐focused interventions in health and social service settings are recommended. There are opportunities to provide multifocal individual and relational interventions within existing services that work with parents to help prevent the likelihood and impact of transmission of intergenerational relational trauma within families. Nurses are well placed to provide preventative interventions in mental health, early childhood and primary health settings. [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]

During the preschool years (3-5 years), children living with parental mental illness are more at risk of various adverse developmental outcomes, compared to other children. Early childhood services are opportune settings for prevention and early intervention strategies that may support preschool children living with parental mental illness. However, there is limited research examining how the early childhood sector supports the child, parent and family. The aim of the study was to explore family focused practices within the early childhood sector in terms of the level of self-perceived knowledge, skill and confidence; and compare the self-perceived knowledge, skill and confidence between preschool teachers and childcare workers. A sample of 40 preschool teachers and 39 childcare providers rated themselves across eight domains that describe their knowledge, confidence and skill using the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Overall, the sample rated themselves positively across all domains. In a cross-sectional analysis, a t-statistic comparison of preschool teachers and childcare providers showed that childcare providers scored significantly higher than preschool teachers in parenting support, referrals and assessing the impact of parental illness on the child. Future studies might identify the barriers and enablers for Family Focus Practice (FFP) across different groups of workers in the early childhood sector. [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]

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]

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]

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]

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]

Summary Planed frozen-hydrated (FH) bulk biological samples of chicken retina were analysed by X-ray elemental imaging in a scanning electron microscope and reanalysed after freeze-drying in the microscope column. Sequential elemental imaging of the same bulk sample in this way provides improved information on element distributions. There was no evidence of element redistribution during the freeze-drying process. Quantitative elemental images were obtained and interpreted to deduce relative and absolute element concentrations in different regions of the retina. Water concentrations were determined from the difference in oxygen concentrations at 15 kV and 5 kV in FH and freeze-dried (FD) samples, respectively. Two accelerating voltages were used to maintain similar X-ray excitation volumes. Water concentrations were also estimated by relating measured oxygen concentration in FH samples to the concentration of oxygen in solutions of a generalized protein in water and by comparing concentrations of phosphorous or sulphur in the FH and FD states. [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]

Introduction/Purpose Methods Results Discussion Conclusion The coronavirus disease (COVID‐19) is a widely spread viral infectious disease, which can impact multiple organs, including the liver. Elevated liver enzymes have been reported in COVID‐19 patients; however, potential changes in liver stiffness following the viral infection remain uncertain. The main aim of this pilot study was to determine if there is a significant difference in liver stiffness between individuals who have never been infected with COVID‐19 and those who had been infected with COVID‐19 <6 months, experiencing only mild symptoms. The secondary aim was to compare the liver stiffness between participants infected with COVID‐19 depending on the elapsed time since infection.Two‐dimensional shear wave elastography (2D‐SWE) was performed prospectively on 68 participants. Thirty‐four participants had been infected with COVID‐19 (all for <6 months) (COVID‐19 group), and another 34 had never been infected with COVID‐19 (control group). The mean 2D‐SWE measurements of both the COVID‐19 group and the control group were compared using an independent t‐test. The mean 2D‐SWE measurements of the COVID‐19 subgroups A (<2 months), B (2 to <4 months) and C (4 to <6 months) were compared using a one‐way ANOVA test (P < 0.05).The (mean ± standard deviation) liver stiffness (kPa) of the COVID‐19 group (5.26 ± 1.63 kPa) was significantly higher than the control group (4.30 ± 0.96 kPa) (P = 0.005). There was no significant difference in liver stiffness among subgroups A (5.20 ± 1.79 kPa), B (4.70 ± 1.53 kPa) and C (5.96 ± 1.48 kPa) (P = 0.143) respectively.The mean liver stiffness of 4.30  ±  0.96k Pa in the control group showed a high probability of being normal as per guidelines. Conversely, the mean liver stiffness of 5.26  ±  1.63 kPa in the COVID‐19 group exhibited a statistically significant increase compared to the control group. However, compensated advanced chronic liver disease was ruled out without other known clinical signs, as per guidelines.A statistically significant increase in liver stiffness value was observed in the post‐COVID‐19 infection group compared to the group who had never been infected. This highlights the potential for short‐term impact on liver stiffness associated with COVID‐19 infection. However, it is unclear if these changes in liver stiffness are associated with liver injury. Further study is warranted to investigate the effects of COVID‐19 infection and its long‐term impact on the liver. [ABSTRACT FROM AUTHOR]

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. [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]

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long‐term impacts. Child‐centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre‐post, mixed methods, single‐arm evaluation of a co‐designed social support intervention with parents and children (4–18 years) measured parents' mental health (PHQ‐9), perceived social support (ENRICHD), parental self‐efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen‐27), and child service use (CAMHSRI‐EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty‐nine parents and 21 children completed baseline and follow‐up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD −1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self‐efficacy was potentially reduced (MD −0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent–child relationships. This study contributes to an emerging evidence base for co‐designed child‐centred interventions to prevent the transgenerational transmission of poor mental health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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]

Abstract: 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. [ABSTRACT FROM AUTHOR]

Abstract: Social connection is a fundamental human need, but challenging for individuals with characteristics that are socially stigmatized. Parenting with mental illness presents obstacles, as well as opportunities, for connection. In the present study, we examined connectedness within a personal recovery paradigm for rural mothers with a mental illness. In‐depth interviews with 17 mothers with a mental illness, utilizing constructivist grounded theory, resulted in six categories of meaning, including ‘yearning for connection’, ‘connecting intensely’, ‘encountering rejection and exclusion’, ‘choosing isolation’, ‘being known’, and ‘finding peers/helping others’. Women expressed a strong desire for connection, but for many, prior experiences of trauma and rejection created barriers to the development of trust, preventing some women from seeking opportunities for connection. Connectedness to self and significant others, and a broader life meaning and purpose can support and expedite personal recovery from mental illness for rural women. However the factors that contribute to the mental illness might also inhibit the development of trust needed to attain social connection. Increasing connectedness in mothers with mental illness is a complex endeavour requiring concerted focus as distinct from other service‐delivery goals. The perinatal period could be a key time for intervention. [ABSTRACT FROM AUTHOR]

Objective: The development of a positive identity beyond the mental illness has been highlighted as an important component of personal recovery. However, the experience of parenting is often overlooked in recovery discourse. This review aims to explore what the literature reveals about the process of developing a positive identity as part of personal recovery and how this may be shaped by the mothering role. Method: A systematic literature search of 5 databases resulted in 27 articles being reviewed, with findings extracted and analyzed using constant comparative analysis. Evidence on the construct and scope of identity in recovery for mothers with mental illness was critically analyzed in the context of a personal recovery conceptual framework. Results: The findings highlight that identity was rarely overtly defined in this literature, although the importance of motherhood was emphasized. Common barriers to uninterrupted and rewarding motherhood included illness and treatment, self-criticism, unsupportive families, discriminatory attitudes, and challenging relationships with children marred by intense and difficult emotions. The important role that psychiatric services can play but rarely do was a common finding. Conclusions and Implications for Practice: Personal recovery from mental illness is more effectively facilitated through supporting mothers to build positive, realistic, and diverse identities that allow them to acknowledge and respond to their mental health needs without fearing the loss of their parenting role or conforming to restrictive gendered stereotypes. [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]

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]

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]

Goal setting is an important element within mental health recovery models; however, parenting and children are rarely recognized in such approaches. This study outlines a family recovery planning model where a parent has a mental health or dual substance and mental health problem. The differences between family types (parent with a mental illness or parent with dual diagnosis) and family members (parent and children) are illustrated in terms of goals across 11 domains. There were a total of 33 parents and 50 children from 10 mental illness and 10 dual diagnosis families. Education and specifically mental health knowledge are important goals across all families and appear especially important for children whose parent has a dual diagnosis. Specific goals and achievement levels for each type of family and parents and children are also outlined. Clear areas for action by clinicians and family members are indicated by this study. [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]

Background and Purpose: The nitric oxide system has two proposed sites and mechanisms of action within the ocular growth/refractive compensation platform-neuromodulatory effects on retinal physiology, and vascular/smooth muscle effects in the choroid. The relative contribution of these mechanisms are tested here with drugs that perturb the nitric oxide system and with slow flicker modulation of the ON and OFF pathways of the retina.Experimental Approach: Intravitreal injection of saline or 900 nmol N(G) -nitro-L-arginine methyl ester or L-arginine in saline was followed by monocular defocus with ±10 D lens (or no lens), from days 5-9 under standard diurnal (SD) or daytime 1 Hz ramped flicker conditions. Biometric, electrophysiological and histological analyses were conducted.Key Results: After 4 days of SD conditions, both drugs enhanced electroretinogram (ERG) b-wave cf. d-wave amplitudes compared with saline and reduced refractive compensation to -10 D lenses. Under flicker conditions compensation to +10 D lenses was suppressed. Choroidal thinning was observed in the drug, no lens groups under SD conditions, whereas choroidal thickening was seen in most groups under flicker conditions, irrespective of refractive outcomes.Conclusions and Implications: As choroidal thickness was not predictive of final refractive compensation across any of the variables of drug, defocus sign or light condition, it is unlikely that choroidal thickness is a primary mechanism underlying refractive compensation across the range of parameters of this study. Rather, the changes in refractive compensation observed under these particular drug and light conditions are more likely due to a neuromodulatory action on retinal ON and OFF pathways. [ABSTRACT FROM AUTHOR]

Myelin oligodendrocyte glycoprotein (MOG) is a minor component of central nervous system myelin presumably implicated in the pathogenesis of Multiple Sclerosis (MS). Immunization with MOG leads to the development of Experimental Autoimmune Encephalomyelitis (EAE), the experimental model of MS. It has been suggested that its encephalitogenic potential may be due to the lack of MOG self-immune tolerance. To clarify this, we have generated a MOG deficient mouse (MOG−/−) strain. Surprisingly, MOG35–55specific proliferation and Th1-type cytokine production were markedly enhanced in MOG−/−mice compared to wild type control. Furthermore, adoptive transfer of MOG35–55specific T cells, isolated from MOG deficient mice, into wild-type recipients resulted in the development of a more severe disease, indicating a high capacity of MOG−/−T cells to initiate effector responses. Interestingly, T cell reactivity to overlapping MOG peptides in MOG−/−mice did not reveal new potential immunodominant epitopes in H-2bmice. Taken together, our data suggests that MOG self-tolerance modulates the encephalitogenic potential of autoreactive MOG T cells in the periphery. [Copyright &y& Elsevier]

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]

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]

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]

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]

The family-focused mental health intervention, 'Let's Talk About Children,' has positively influenced the lives of families affected by parental mental illness. This paper outlines the use of this brief, strengths-based intervention for parents with gambling and other co-occurring issues from the gamblers' support services sector. Over a six-month period, a training manual and accompanying resources were adapted for the gamblers' support services sector and a targeted training session developed. Nine problem gambling counsellors from three Victorian gambling support services trialled the Let's Talk About Children intervention over a four-month period. Qualitative data were gathered through focus groups, interviews, and practice enquiry groups to determine the impact of the Let's Talk About Children model for gambling support services. The results are presented as 'practice wisdoms and recommendations' reporting on the impact of the trial and to provide some guidance to support others in the implementation of a specific family-focused intervention. This paper reports on the first exploratory trial of Let's Talk About Children for the gambler's support services sector in Australia. [ABSTRACT FROM AUTHOR]

The measurement of stress and coping in adolescents has received some attention; however, the understanding and development of measures of how children cope has not kept pace. This study reports the conceptual development and psychometric properties of the Kids Coping Scale (KCS), a brief self-report measure of problem, emotion and social support coping dimensions. Participants were 834 children aged 7–13 years of whom 390 were male (48.6 per cent) with a mean age of 9.88 years and 415 were female (49.6 per cent) with a mean age of 9.87 years. Principal components analysis did not support a hypothesized three-factor structure; however a clear two-factor structure (cross-validated) distinguishing problem and emotion-focused coping actions did emerge. The KCS returned low to moderate levels of internal consistency and low to moderate correlations with other relevant constructs (e.g. self esteem, parent responded strengths and difficulties). The findings highlight a clear problem- and emotion-focused structure in a brief measure considered suitable for children 7 years and above. Weaknesses of the scale are outlined along with implications for the future developments to the KCS being identified. Copyright © 2008 John Wiley & Sons, Ltd. [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]