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Grant A, McCartan C, Davidson G, Bunting L, Cameron J, McBride O, Mulholland C, Murphy J, Nolan E, Schubotz D, Shevlin M. Prevalence and risk factors of parental mental health problems: A cross-sectional study. Int J Ment Health Nurs 2024. [PMID: 38867456 DOI: 10.1111/inm.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 06/14/2024]
Abstract
An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ-12), in a representative sample of parents and caregivers of children and young people (2-19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems.
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Affiliation(s)
- Anne Grant
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK
| | - Claire McCartan
- IMPACT Centre, Northern Health & Social Care Trust, Antrim, UK
| | - Gavin Davidson
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Lisa Bunting
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Julie Cameron
- Mental Health Foundation, University of Manchester, Manchester, UK
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, UK
| | - Ciaran Mulholland
- IMPACT Centre, Northern Health & Social Care Trust, Antrim, UK
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, UK
| | - Emma Nolan
- School of Psychology, Ulster University, Coleraine, UK
| | - Dirk Schubotz
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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Piché G, Villatte A, Clément MÈ, Morin MH, Maybery D, Reupert A, Richard-Devantoy S, Fournier-Marceau M. Predictors of family-focused practices among mental health workers in Quebec. Front Psychiatry 2024; 15:1380001. [PMID: 38803674 PMCID: PMC11128615 DOI: 10.3389/fpsyt.2024.1380001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Context Engaging family members in the ongoing care of individuals with mental illness is a practice known to bolster the client's recovery journey and enhance the overall wellbeing of both children and families involved. Despite its potential benefits, there remains a dearth of understanding surrounding the implementation of family-focused practices (FFP) by mental health professionals serving adults, as well as the factors that could either promote or hinder such practices. This knowledge gap is particularly pronounced within North American settings. Goal The goal of this study was to identify potential hindering and enabling factors of FFP used in adult mental health services. Methods A sample of 512 professionals working with adult mental health clients, from all regions of Quebec, Canada, with a variety of disciplinary backgrounds and working in different work settings, completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Multinominal logistic regression analysis was performed to assess the impact of several factors - organizational, professional, and personal - on the degree of family-based practices of mental health workers. Results and discussion Findings of this study show that the strongest predictors for the adoption of higher FFP levels among adult mental health professionals in Quebec, are being employed on a full-time basis, perceiving a higher level of skills, knowledge, and confidence toward FFP, and having a supportive workplace environment. Results underscore the need to address both organizational and worker-related aspects to effectively promote better FFP in mental health services.
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Affiliation(s)
- Geneviève Piché
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Centre de Recherche Universitaire Sur les Jeunes et les Familles (CRUJEF), Québec, QC, Canada
- Réseau de recherche en santé des populations du Québec (RRSPQ), Montréal, QC, Canada
| | - Aude Villatte
- Centre de Recherche Universitaire Sur les Jeunes et les Familles (CRUJEF), Québec, QC, Canada
- Unité de Formation et de Recherches (UFR) de Psychologie, Université Toulouse Jean Jaurès, Laboratoire Psychologie de la Socialisation - Développement et Travail (PSDT), Toulouse, France
| | - Marie-Ève Clément
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Marie-Hélène Morin
- Département de travail social, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Darryl Maybery
- Department of Rural and Indigenous Health, Monash University, Melbourne, VIC, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counseling, Monash University, Melbourne, VIC, Australia
| | - Stéphane Richard-Devantoy
- Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Montréal, QC, Canada
| | - Marianne Fournier-Marceau
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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Vives-Espelta J, Ortega-Sanz L, Ferré-Grau C, Burjalés-Martí MD. Lived experiences of mental health nurses who care for clients who are parents: An approximation of Tronto's definition of care. J Psychiatr Ment Health Nurs 2024. [PMID: 38477635 DOI: 10.1111/jpm.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role. Many authors highlight the importance of a non-judgmental approach when providing support and care to clients with mental illness who are parents. Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked. There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Trust is the basis that helps clients to be open to receiving care and answering parenting-related questions. Therefore, without adequate professional-client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client. Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. WHAT ARE THE IMPLICATIONS FOR PRACTICE Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. ABSTRACT Introduction Many authors highlight the importance of a non-judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim To explore the lived experiences of mental health nurses who care for clients who are parents. Method We conducted a qualitative phenomenological study. The main data collection technique was in-depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting-related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.
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Affiliation(s)
- Judit Vives-Espelta
- Departament d'Infermeria, Grup de Recerca Avançada en Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Laura Ortega-Sanz
- Departament d'Infermeria, Grup de Recerca GAP, Hospital Universitari Institut Pere Mata, CIBERSAM, Universitat Rovira i Virgili, Tarragona, Spain
| | - Carme Ferré-Grau
- Departament d'Infermeria, Grup de Recerca Avançada en Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maria-Dolors Burjalés-Martí
- Departament d'Infermeria, Grup de Recerca Avançada en Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Yao H, Guan L, Zhou T, Zhang C, Pan Y, Han J, He R, Chang Z, Du C, Wu T, Sun J, Yuan Y, Maybery D, Ma H. Factors that influence family-focused practice in Chinese mental health workers: A cross-sectional survey. J Psychiatr Ment Health Nurs 2023; 30:1216-1230. [PMID: 37401449 DOI: 10.1111/jpm.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Family-focused practice has become an emerging paradigm in mental health services. However, little is known about family-focused practice and associated factors in Chinese mental health workers. AIM To examine family-focused practice and associated factors in Chinese mental health workers. METHOD A cross-sectional survey was conducted in a convenience sample of mental health workers (n = 515) in Beijing, China. The Family-Focused Mental Health Practice Questionnaire was used to measure family-focused practice, as well as worker, workplace and client factors that might influence family-focused practice. Multiple linear regression analysis was performed to investigate the factors associated with family-focused practice. RESULTS On average, the participants exhibited a moderate level of engagement in family-focused practice. The factors that most significantly influenced family-focused practice in Chinese mental health workers were skill and knowledge, worker confidence and time and workload. Moreover, psychiatrists were found to engage more in family-focused practice than psychiatric nurses, and community mental health workers were more active in family-focused practice than hospital-based ones. DISCUSSION This study provided important data concerning family-focused practice and associated factors in Chinese mental health workers. IMPLICATIONS FOR PRACTICE The varying level of Chinese mental health workers to engage in family-focused practice has advocacy, training, research and organizational implications for mental health services in China and elsewhere.
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Affiliation(s)
- Hao Yao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lili Guan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianhang Zhou
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Changchun Zhang
- Fangshan District Mental Health Care Hospital, Beijing, China
| | - Yang Pan
- Fangshan District Mental Health Care Hospital, Beijing, China
| | - Jinxiang Han
- Beijing Xicheng District Ping'an Hospital, Beijing, China
| | - Rui He
- Mental Health Prevention Hospital of Haidian District, Beijing, China
| | - Zhengjiao Chang
- Mental Health Prevention Hospital of Haidian District, Beijing, China
| | - Chunyu Du
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tingfang Wu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jingwen Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yilin Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Darryl Maybery
- Monash University Department of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Warragul, Victoria, Australia
| | - Hong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Tuck M, Wittkowski A, Allott R, Gregg L. What about the children? Adult mental health practitioners' experiences and views of family-focused practice in Early Intervention Services. Psychol Psychother 2023; 96:697-715. [PMID: 37017306 DOI: 10.1111/papt.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND There is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family-focused practice (FFP) emphasises the "whole family" as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK. METHODS Sixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis. RESULTS Five core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professional and personal experience, and preconceptions of families influenced delivery, and in turn, the engagement approach they adopted impacted families' responsiveness. The diversity and dynamics of service user families such as age, socioeconomic status, culture and stigma impacted FFP. An operational context characterised by insufficient resources reduced FFP; however, organisational structures such as leadership, clinical supervision and multi-disciplinary teams facilitated FFP. CONCLUSIONS FFP is not yet embedded within Early Intervention Services. Practice recommendations include agreeing on a formal definition of FFP and its scope; the development of FFP policy; clarity in relation to staff responsibilities and identities; the adoption of a collaborative approach which encourages service user choice and for time to be ring-fenced to prioritise FFP. Future research should ascertain service user and family views on the facilitators and barriers to engaging with FFP in Early Intervention Services.
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Affiliation(s)
- Molly Tuck
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rory Allott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lynsey Gregg
- School of Health Sciences, University of Manchester, Manchester, UK
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6
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Grant A, Lagdon S, Devaney J, Davidson G, Duffy J, Perra O. Validation of the family focused mental health practice questionnaire in measuring health and social care professionals' family focused practice. PLoS One 2023; 18:e0285835. [PMID: 37216367 DOI: 10.1371/journal.pone.0285835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Parental mental illness is a major public health issue and there is growing evidence that family focused practice can improve outcomes for parents and their families. However, few reliable and valid instruments measure mental health and social care professionals' family focused practice. OBJECTIVES To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals. METHODS Health and Social Care Professionals (n = 836) in Northern Ireland completed an adapted version of the Family Focused Mental Health Practice Questionnaire. Exploratory factor analysis was used to test the structure of the underlying dimensions in the questionnaire. The results, and theoretical considerations, guided construction of a model that could explain variation in respondents' items. This model was then validated using confirmatory factor analysis. RESULTS Exploratory factor analysis revealed that solutions including 12 to 16 factors provided a good fit to the data and indicated underlying factors that could be meaningfully interpreted in line with existing literature. From these exploratory analyses, we derived a model that included 14 factors and tested this model with Confirmatory Factor Analysis. The results suggested 12 factors that summarized 46 items that were most optimal in reflecting family focused behaviours and professional and organizational factors. The 12 dimensions identified were meaningful and consistent with substantive theories: furthermore, their inter-correlations were consistent with known professional and organizational processes known to promote or hinder family focused practice. CONCLUSION This psychometric evaluation reveals that the scale provides a meaningful measure of professionals' family focused practice within adult mental health and children's services, and the factors that hinder and enable practice in this area. The findings, therefore, support the use of this measure to benchmark and further develop family focused practice in both adult mental health and children's services.
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Affiliation(s)
- Anne Grant
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Susan Lagdon
- School of Psychology, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - John Devaney
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Joe Duffy
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Oliver Perra
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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Tuck M, Wittkowski A, Gregg L. A Balancing Act: A Systematic Review and Metasynthesis of Family-Focused Practice in Adult Mental Health Services. Clin Child Fam Psychol Rev 2023; 26:190-211. [PMID: 36318397 PMCID: PMC9879847 DOI: 10.1007/s10567-022-00418-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
Parental mental illness is a major international public health concern given its implications for whole families, including children. Family-focused practice (FFP), an approach that emphasises a "whole-family" approach to care, provides an opportunity to mitigate the significant risks associated with parental mental health difficulties. The positive benefits associated with FFP have led to a shift in policy and practice towards prioritising FFP within adult mental health services. However, evidence suggests that FFP remains scarce and is not routine. Research has identified the important role of practitioners in facilitating FFP. The current review identified, synthesised and appraised the international qualitative literature examining adult mental health practitioners' implementation experiences of FFP. It aimed to provide an evidence-informed account of practitioner experiences of FFP delivery and to identify key recommendations to enhance future FFP outcomes in AMHS. Ovid Medline, PsycInfo, CINAHL plus, EMBASE and Web of Science Core Collection were searched systematically, in line with PRISMA guidance, up to January 2022. The Critical Appraisal Skills Programme (CASP) was used to undertake the quality appraisal prior to a thematic synthesis being conducted. The review was registered on PROSPERO. Nineteen papers, spanning 17 years of research with 469 practitioners, were included. Three main themes and 14 subthemes were developed, representing different aspects of practitioner experiences of FFP delivery. Practitioners' approach to FFP was variable and influenced by their beliefs about FFP, perceived roles and responsibilities, competence, service setting, and personal parenting status. Practitioners engaged in a balancing act to maintain a dual focus on their service-users and their children, to navigate powerful emotions, and consider multiple perspectives in a biomedical organisational structure that advocates individualised treatment. Although working together unified teams, a greater need for external interagency collaboration was identified. The use of strength-based approaches with clients and dedicated staff resources, within clear guidelines and frameworks, was reported to be necessary to maximise FFP delivery. This review proposes a complex FFP dynamic whereby practitioners engage in a constant balancing act between FFP stakeholders to achieve meaningful FFP outcomes for service-users and their families. Service recommendations are provided.
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Affiliation(s)
- M Tuck
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - A Wittkowski
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- School of Health Sciences, The University of Manchester, Manchester, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
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8
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Dean L, Buechner H, Moffett B, Maritze M, Dalton LJ, Hanna JR, Rapa E, Stein A, Tollman S, Kahn K. Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa. BMC Psychiatry 2023; 23:78. [PMID: 36707793 PMCID: PMC9883085 DOI: 10.1186/s12888-023-04569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. METHODS A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. RESULTS Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations. CONCLUSIONS This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
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Affiliation(s)
- Lucy Dean
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hadassah Buechner
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Bianca Moffett
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J. Dalton
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey R. Hanna
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Alan Stein
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Reupert A, Bee P, Hosman C, van Doesum K, Drost LM, Falkov A, Foster K, Gatsou L, Gladstone B, Goodyear M, Grant A, Grove C, Isobel S, Kowalenko N, Lauritzen C, Maybery D, Mordoch E, Nicholson J, Reedtz C, Solantaus T, Stavnes K, Weimand BM, Yates S, Ruud T. Editorial Perspective: Prato Research Collaborative for change in parent and child mental health - principles and recommendations for working with children and parents living with parental mental illness. J Child Psychol Psychiatry 2022; 63:350-353. [PMID: 34582039 PMCID: PMC9293418 DOI: 10.1111/jcpp.13521] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Andrea Reupert
- School of Educational Psychology and CounsellingFaculty of EducationMonash UniversityClaytonVic.Australia
| | - Penny Bee
- Division of Nursing, Midwifery & Social WorkUniversity of ManchesterManchesterUK
| | - Clemens Hosman
- Department Clinical PsychologyRadboud UniversityNijmegenThe Netherlands,Department of Health PromotionMaastricht UniversityMaastrichtThe Netherlands
| | - Karin van Doesum
- Department Clinical PsychologyRadboud UniversityNijmegenThe Netherlands,UiT The Artic University of NorwayTromsoNorway
| | - Louisa M. Drost
- Rob Giel Research CenterUniversity Medical Center GroningenGroningenThe Netherlands
| | - Adrian Falkov
- Child & Youth MH ServiceRoyal North Shore HospitalSydneyNSWAustralia
| | - Kim Foster
- School of Nursing, Midwifery & ParamedicineAustralian Catholic UniversityMelbourneVic.Australia,NorthWestern Mental HealthMelbourne HealthMelbourneVic.Australia
| | - Lina Gatsou
- Child and Adolescent Mental Health ServicesLeicestershire Partnership NHS TrustLeicesterUK,The Faculty of Health and Life SciencesDe Montford UniversityLeicesterUK
| | - Brenda Gladstone
- Social & Behavioural Health Sciences DivisionDalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Melinda Goodyear
- School of Rural HealthMonash UniversityWarragulVic.Australia,Emerging MindsHiltonSAAustralia
| | - Anne Grant
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Christine Grove
- School of Educational Psychology and CounsellingFaculty of EducationMonash UniversityClaytonVic.Australia
| | - Sophie Isobel
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
| | - Nick Kowalenko
- Emerging MindsHiltonSAAustralia,Sydney Children's Hospital Dr NetworkDepartment of Psychological Medicine Children's HospitalUniversity of SydneyWestmeadNSWAustralia
| | - Camilla Lauritzen
- Regional Center for Child and Youth Mental Health and WelfareFaculty of Health SciencesUiT – Arctic University of NorwayTromsoNorway
| | - Darryl Maybery
- School of Rural HealthMonash UniversityWarragulVic.Australia
| | - Elaine Mordoch
- College of NursingRady Faculty of Health SciencesUniversity of ManitobaWinnipegMBCanada
| | - Joanne Nicholson
- Heller School for Social Policy and ManagementInstitute for Behavioral HealthSchneider Institutes for Health PolicyBrandeis UniversityWalthamMAUSA
| | - Charlotte Reedtz
- Regional Center for Child and Youth Mental Health and WelfareFaculty of Health SciencesUiT – Arctic University of NorwayTromsoNorway
| | - Tytti Solantaus
- Mental Health UnitFinnish Institute for Health and WelfareHelsinkiFinland
| | - Kristin Stavnes
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Nordland Hospital TrustBodøNorway
| | - Bente M. Weimand
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK,Department of Health, Social and Welfare StudiesUniversity of South‐Eastern NorwayDrammenNorway,Mental Health ServicesAkershus University HospitalLørenskogNorway
| | - Scott Yates
- School of Applied Social SciencesDe Montfort UniversityLeicesterUK
| | - Torleif Ruud
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Mental Health ServicesAkershus University HospitalLørenskogNorway
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10
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Vives-Espelta J, Burjalés-Martí MD, Ferré-Grau C. Nurses' views and practices on parental mental illness: An integrative review. Int J Ment Health Nurs 2022; 31:8-24. [PMID: 34623021 DOI: 10.1111/inm.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
When a parent has a mental health problem, family members can be affected by it. Nursing professionals can provide care for the whole family, including children. Nurses can support the parental role of parents with mental illness. This integrative review aimed at the following: To identify and to synthesize the views and practices of nurses on parental mental illness (PMI). An integrative review methodology was employed, following PRISMA guidelines. Theoretical and empirical literature was included. Twenty-three articles were obtained to be analysed, using the Whittemore and Knafl approach. A lack of knowledge about nurses' views and practices on PMI was found. Especially, in some demographic areas such as Mediterranean countries and Central and South America. Different issues which influence how nurses perceive PMI were identified: subjective meaning of family concept, personal experience of being parent, and perceptions of mental illness, among others. The main findings on nurses' practices were as follows: guidelines to implement family-focused practices, knowledge, and skills; therapeutic relationship; and teamwork and interagency communication; among others. These issues are intimately related. They could act as enablers or barriers to support parental role of parents with mental illness. Adequate guidelines and policies are necessary to support parents with mental illness and their families. There is a need to include knowledge about PMI and family-focused approach in nursing education curricula. Training could include reflection on nurses' experiences and personal values to become aware of how these can affect their interventions and practices.
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Affiliation(s)
- Judit Vives-Espelta
- Member of the Research Group of Advance Nursing SGR 1030, Nursing and Health Programme, Nursing Department, Faculty of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maria-Dolors Burjalés-Martí
- Member of the Research Group of Advance Nursing SGR 1030, Nursing Department, Faculty of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Carme Ferré-Grau
- Coordinator of the Research Group of Advance Nursing SGR 1030, Nursing Department, Faculty of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
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11
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Leonard R, Linden M, Grant A. Personal and professional influences on health visitors' family focused practice for maternal mental illness: a cross sectional study. BMC Health Serv Res 2022; 22:113. [PMID: 35081961 PMCID: PMC8790840 DOI: 10.1186/s12913-022-07499-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/14/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Family focused practice (FFP) is an approach that recognises the inter-related needs of family members and recommends a continuum of activities to support families. While it is recognised that health visitors play a key role in supporting families when mothers have mental illness, there is limited understanding of health visitor's family focused practice (FFP) in this context and its relationships with factors, such as, workload, training, skill and knowledge, and personal and professional experience. This paper examined the effect of health visitors' interaction with the family, and personal and professional experience on their family focused practice. METHODS A cross sectional questionnaire (Family Focused Mental Health Practice Questionnaire) was distributed to 488 health visitors within community practice in Northern Ireland, with 230 choosing to take part. Independent t-tests and one-way analysis of variance were used to compare family focused practice scores. RESULTS Results found that health visitors who had face to face contact with partners and children (t(221) = 2.61, p = .01), and those that directly supported the partner (t(221) = 2.61, p = 0.01) had a significantly higher mean score of FFP, than those that did not. However, frequency of visits (daily, weekly, monthly or yearly) had no effect on family focused practice scores. Training also had a significant effect on family focused practice scores (F(2,221) = 4.841, p = 0.029). Analysis of variance revealed that personal experience of mental illness had a significant effect on scores (M = 97.58, p = 0.009), however variables such as, age, parental status, time since registration, and being in a specialist position had no effect. CONCLUSIONS In order for family focused practice to be effective, the quality, and content of visits and contact with family should be addressed, as opposed to a focus on the quantity of visits. However, in order for this to occur health visitors need to have appropriate support in their own right, with manageable caseloads and resources.
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Affiliation(s)
- Rachel Leonard
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Mark Linden
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Anne Grant
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
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12
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Furlong M, Mulligan C, McGarr S, O'Connor S, McGilloway S. A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective. Front Psychiatry 2021; 12:783161. [PMID: 34887791 PMCID: PMC8649663 DOI: 10.3389/fpsyt.2021.783161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise "gap," very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings. Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework. Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change). Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a "think family" infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.
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13
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Maybery D, Jaffe IC, Cuff R, Duncan Z, Grant A, Kennelly M, Ruud T, Skogoy BE, Weimand B, Reupert A. Mental health service engagement with family and carers: what practices are fundamental? BMC Health Serv Res 2021; 21:1073. [PMID: 34627245 PMCID: PMC8502279 DOI: 10.1186/s12913-021-07104-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Substantial and important benefits flow to all stakeholders, including the service user, when mental health services meaningfully engage with carers and family members. Government policies around the world clearly supports inclusiveness however health service engagement with family and carers remains sporadic, possibly because how best to engage is unclear. A synthesis of currently used surveys, relevant research and audit tools indicates seven core ways that families and carers might be engaged by health services. This study sought to confirm, from the perspective of family and carers, the importance of these seven health service engagement practices. METHODS In a mixed method online survey, 134 family members and carers were asked what they received and what they wanted from mental health services. Participants also quantified the importance of each of the seven core practices on a 0-100 point likert scale. RESULTS Almost 250 verbatim responses were deductively matched against the seven themes, with additional unaligned responses inductively categorised. The findings triangulate with multiple diverse literatures to confirm seven fundamental engagement practices that carers and family want from health services. Conceptually, the seven practices are represented by two broad overarching practice themes of (i) meeting the needs of the family member and (ii) addressing the needs of the service user. CONCLUSION Policy, clinical practice, training and future research might encompass the seven core practices along with consideration of the intertwined relationship of family, carers and the service user suggested by the two broader concepts.
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Affiliation(s)
| | | | - Rose Cuff
- Satellite Foundation, Melbourne, Australia
| | | | | | | | - Torleif Ruud
- Akershus University Hospital, Nordbyhagen, Norway
| | | | - Bente Weimand
- University of South-Eastern Norway, Notodden, Norway
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14
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Allchin B, Weimand BM, O'Hanlon B, Goodyear M. A Sustainability Model for Family-Focused Practice in Adult Mental Health Services. Front Psychiatry 2021; 12:761889. [PMID: 35115958 PMCID: PMC8804966 DOI: 10.3389/fpsyt.2021.761889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Becca Allchin
- School of Rural Health, Monash University, Melbourne, VIC, Australia.,Eastern Health, Mental Health Program, Melbourne, VIC, Australia
| | - Bente M Weimand
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia.,Emerging Minds, Hilton, SA, Australia
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15
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Lesinskiene S. An Exploration of the Possibilities of Current Mental Health Services to Tackle Transgenerational Effects of Parental Mental Illnesses on Offspring Adjustment in Lithuania. Front Psychiatry 2021; 12:764394. [PMID: 34777066 PMCID: PMC8586550 DOI: 10.3389/fpsyt.2021.764394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
The topic of mental health and mental disorders is very sensitive and delicate in families and the society. Stigma is one of the main reasons for little help-seeking for mental disorders. Transgenerational effects of mental disorders is the utmost sensitive theme that brings difficulties for service organization and research. By emphasizing the importance of the effects of parental mental illnesses on the health of offspring and their adjustment, together with sharing the international experience between professionals, both the administration of services and society could provide opportunities for further positive change in this little-studied but utmost actual field. There is still a lack of appropriate long term systematic programs and ways to overcome complex organizational challenges. Sharing international experience and research could help find ways that best fit the situations in each country. After a descriptive analysis of the current system of mental health services in Lithuania, opportunities were sought to meet the needs of children and adolescents whose parents have mental disorders by ensuring their healthy psychosocial development. Child and adolescent psychiatry services are a more favorable and less stigmatized area in Lithuania than adult psychiatry, so assistance and specialized programs for children of parents with mental health problems could be organized using the country's relatively well-developed network of child and adolescent psychiatric and pediatric services. For such a small country with limited resources, there could be a possibility to use and strengthen the existing network of services together with finding opportunities for mixed models of financing and cooperation with non-governmental initiatives and organizations. A unique network of primary mental health outpatient centers that provide services for adults and children/adolescents could serve as a reasonable basis for the systematic implementation of specialized programs and initiatives in this field. This network is still not adequately used in the organization of mental health prevention, early intervention, and complex treatment services for the children of parents with mental illness.
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Affiliation(s)
- Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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16
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Allchin B, O'Hanlon B, Weimand BM, Goodyear M. Practitioners' application of Let's Talk about Children intervention in adult mental health services. Int J Ment Health Nurs 2020; 29:899-907. [PMID: 32271500 DOI: 10.1111/inm.12724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Becca Allchin
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia.,Eastern Health Mental Health Program, Ringwood East, Vic., Australia
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Vic., Australia
| | - Bente M Weimand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Melinda Goodyear
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia.,Emerging Minds, Hilton, SA, Australia
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17
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Allchin B, Goodyear M, O'Hanlon B, Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused intervention in mental health services. J Psychiatr Ment Health Nurs 2020; 27:616-627. [PMID: 32037644 DOI: 10.1111/jpm.12615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Becca Allchin
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Eastern Health Mental Health Program, Melbourne, Vic., Australia
| | - Melinda Goodyear
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Emerging Minds, Hilton, SA, Australia
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Vic., Australia
| | - Bente M Weimand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,School of Nursing and Midwifery, Queens University Belfast, Belfast, Northern Ireland
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18
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Grant A, Falkov A, Reupert A, Maybery D, Goodyear M. An exploration of whether mental health nurses practice in accordance with The Family Model. Arch Psychiatr Nurs 2020; 34:244-250. [PMID: 32828356 DOI: 10.1016/j.apnu.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Anne Grant
- Queens University Belfast, Mental Health, School of Nursing and Midwifery, 97 Lisburn Rd, BT9 7BL, United Kingdom of Great Britain and Northern Ireland.
| | - Adrian Falkov
- Royal North Shore & Sydney Children's Hospitals, Sydney, New South Wales, Australia.
| | - Andrea Reupert
- Monash University, Krongold Centre, Clayton, Melbourne 3300, Australia.
| | - Darryl Maybery
- Monash University, Department of Rural and Indigenous Health, School of Rural Health, 3 Ollerton Avenue, Moe 3825, Australia.
| | - Melinda Goodyear
- Monash University, Department of Rural and Indigenous Health, School of Rural Health, 3 Ollerton Avenue, Moe 3825, Australia.
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19
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Leonard R, Linden M, Grant A. Predictors of family focused practice among health visitors: A mixed methods study. J Adv Nurs 2020; 76:1255-1265. [PMID: 32012334 DOI: 10.1111/jan.14310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 01/18/2023]
Abstract
AIMS To determine what predicts health visitors' family-focused practice with mothers who have mental illness. To explore health visitors' experiences of family-focused practice and what factors, if any, enable and/or hinder it. DESIGN A sequential mixed-methods design was employed. METHODS In Phase 1, a total of 230 health visitors, in five Health and Social Care Trusts in the UK were recruited using convenience sampling and completed the Family Focused Mental Health Practice Questionnaire. Three multiple regression models were developed to test whether workload (Model I), professional knowledge (Model II) and health visitors' professional and personal experience (Model III) predicted their family-focused practice. In Phase 2, 10 health visitors, who completed the questionnaire, participated in semi-structured interviews to describe their experiences of family-focused practice. The data collection of the two phases was conducted from September 2017 - September 2018. RESULTS Model III was significant. While personal experience of parenting was positively associated with family-focused practice, length registered as a health visitor and personal experience of mental illness was negatively associated. Qualitative findings suggested that increasing years of professional experience and personal experience of mental illness enabled health visitors to support mothers and their children, but not other adult family members, including partners. Limited skills and knowledge to support mothers with severe mental illness (i.e. schizophrenia) hindered family-focused practice. CONCLUSION This study advances understanding of how health visitors' professional and personal experiences can influence their family-focused practice and highlights the importance of organizations promoting their capacity to support mothers with severe mental illness and to include mothers' partners. IMPACT A clear understanding of factors affecting health visitors' capacity to engage in family-focused practice will help to inform policy, education and practice in health visiting; with potential to improve outcomes for the whole family.
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Affiliation(s)
- Rachel Leonard
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Anne Grant
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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20
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Skogøy BE, Ogden T, Weimand B, Ruud T, Sørgaard K, Maybery D. Predictors of family focused practice: organisation, profession, or the role as child responsible personnel? BMC Health Serv Res 2019; 19:793. [PMID: 31684933 PMCID: PMC6829823 DOI: 10.1186/s12913-019-4553-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/23/2019] [Indexed: 01/15/2023] Open
Abstract
Background Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals’ ability to support the families when patients are parents. Methods Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals’ background and role (N = 280) along with exploring predictors of parent, child, and family support. Results While most health professions had begun to have conversations with parents on children’s needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals). Conclusion The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals’ needs in order to strengthen their ability to better support children and families when a parent is ill.
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Affiliation(s)
- Bjørg Eva Skogøy
- Nordland Hospital Trust, Kløveråsveien 1, 8076, Bodø, Norway. .,The Faculty of Health Science, UiT, The Arctic University of Norway, Box 6050, 9037, Tromsø, Norway.
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Unirand, Box 7053, Majorstuen, 0368, Oslo, Norway.,Institute of Psychology, University of Oslo, Box 1171, Blindern, 0318, Oslo, Norway
| | - Bente Weimand
- Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.,Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Torleif Ruud
- Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Box 1171, Blindern, 0318, Oslo, Norway
| | - Knut Sørgaard
- Nordland Hospital Trust, Kløveråsveien 1, 8076, Bodø, Norway.,The Faculty of Health Science, UiT, The Arctic University of Norway, Box 6050, 9037, Tromsø, Norway
| | - Darryl Maybery
- Monash University Department of Rural Health, Box 973, Moe, Victoria, 3825, Australia
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21
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Ruud T, Maybery D, Reupert A, Weimand B, Foster K, Grant A, Skogøy BE, Ose SO. Adult Mental Health Outpatients Who Have Minor Children: Prevalence of Parents, Referrals of Their Children, and Patient Characteristics. Front Psychiatry 2019; 10:163. [PMID: 31001149 PMCID: PMC6456127 DOI: 10.3389/fpsyt.2019.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: A strong connection exists between parental mental illness and lifetime mental health risk for their children. Thus, it is important to determine, when parents attend for treatment for their illness, the prevalence and characteristics of parents with a mental illness and identify referral actions for their children. Previous studies indicate that 12-45% of adult mental health service patients are parents with minor children. There is a need for studies with larger sample sizes that investigate the prevalence and characteristics of parents, and factors associated with referral actions for their children. Method: Data on 23,167 outpatients was drawn from a national census study across 107 Norwegian adult mental health outpatient clinics during 2 weeks in April 2013. Clinicians identified various socio-demographic characteristics of patients who were parents and referral actions for their children. Results: Eight thousand thirty-five (36%) of outpatients had children under 18 years. Thirty-one percent were provided with referrals for their children and 58% were reported to have children with no need for referral. Three percent were reported to have children with unmet needs who were not referred. There were missing data on children's needs and referral actions for 8% of parents. Patients who care for minor children were more likely to be refugees, and less likely to be single, male, not own a house/apartment, and have a schizophrenia spectrum illness or substance use disorder. Children were more likely to be referred when their parent was single, with no income from paid work, low education, not owning house/apartment, poor family network, long outpatient treatment, and an individual care plan; and less likely for men with a moderate or less severe mental illness. Children were referred to child protection agencies, child and adolescent mental health services and school psychological/pedagogic services. Discussion: The prevalence of outpatients with children is similar to other studies. Referrals were made for children of one third of outpatients with minor children. Needs and referrals of children was unknown for one in ten outpatients. Mental health outpatient clinics must improve procedures to identify parenting status and ascertain and act on children's needs.
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Affiliation(s)
- Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Darryl Maybery
- School of Rural Health, Monash University, Moe, VIC, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Bente Weimand
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia.,NorthWestern Mental Health, Parkville, VIC, Australia
| | - Anne Grant
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
| | - Bjørg Eva Skogøy
- Nordland Hospital Trust, Bodø, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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22
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Potijk MR, Drost LM, Havinga PJ, Hartman CA, Schoevers RA. "…and How Are the Kids?" Psychoeducation for Adult Patients With Depressive and/or Anxiety Disorders: A Pilot Study. Front Psychiatry 2019; 10:4. [PMID: 30804814 PMCID: PMC6371785 DOI: 10.3389/fpsyt.2019.00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/04/2019] [Indexed: 12/29/2022] Open
Abstract
Depressive and anxiety disorders are highly prevalent and form a substantial burden for individuals and their family members. A recent study showed that approximately two-thirds of the children of patients with severe depressive and/or anxiety disorders develop one of these disorders themselves before 35 years of age. In the Netherlands, various preventive interventions are available for children of parents with mental illnesses. However, the actual reach of interventions is small (< 1% of all children participate). A major barrier appeared to be parents' hesitancy to let children participate in preventive programs. In order to address this barrier, we designed a pilot study to implement a psychoeducation program on parenting and mental illnesses. The main aim of this study was to investigate how a preventive family-focused approach can be embedded in routine adult psychiatric care. The pilot started in April 2017 and has ended in September 2018. It was conducted in the University Center Psychiatry (UCP) in Groningen, The Netherlands. This article describes the implementation process so far. The main intervention was a monthly organized group-psychoeducation called "parenting and a mental illness," which could be attended by parents currently treated in the UCP. In 18 months, implementation activities were divided in four phases; (1) Creating awareness, (2) Adoption of the intervention, (3) Implementation and evaluation, and (4) Continuation phase. The program development process was evaluated using both qualitative and quantitative data. Based on the pilot study we were able to make recommendations for the further implementation of this approach so that more parents can be reached in future. Further study with follow-up activities is needed to measure the effects of the psychoeducation, for instance on parenting functioning and the quality of the parent-child interaction.
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Affiliation(s)
- Marieke R Potijk
- University Center for Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Louisa M Drost
- University Center for Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Petra J Havinga
- University Center for Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Catharina A Hartman
- University Center for Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Robert A Schoevers
- University Center for Psychiatry, University Medical Center Groningen, Groningen, Netherlands
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23
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Skogøy BE, Maybery D, Ruud T, Sørgaard K, Peck GC, Kufås E, Stavnes K, Thorsen E, Ogden T. Differences in implementation of family focused practice in hospitals: a cross-sectional study. Int J Ment Health Syst 2018; 12:77. [PMID: 30574174 PMCID: PMC6299542 DOI: 10.1186/s13033-018-0256-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice. METHODS This cross-sectional study examined the adherence of health professionals' (N = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire. RESULTS Overall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children. CONCLUSIONS Differences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support.Trial registration The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.
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Affiliation(s)
- Bjørg Eva Skogøy
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- The Faculty of Health Science, UiT The Arctic University of Norway, Box 6050, 9037 Tromsø, Norway
| | - Darryl Maybery
- Monash University Department of Rural Health, Box 973, Moe, VIC 3825 Australia
| | - Torleif Ruud
- Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Blindern, Box 1171, 0318 Oslo, Norway
| | - Knut Sørgaard
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- The Faculty of Health Science, UiT The Arctic University of Norway, Box 6050, 9037 Tromsø, Norway
| | | | - Elin Kufås
- Vestre Viken Hospital Trust, Box 800, 3004 Drammen, Norway
| | - Kristin Stavnes
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- Institute of Clinical Medicine, University of Oslo, Blindern, Box 1171, 0318 Oslo, Norway
| | - Eivind Thorsen
- BarnsBeste (Children’s Best Interests) - National Competence Network for Children as Next of Kin, Sørlandet Hospital Trust, Box 416, 4604 Kristiansand, Norway
| | - Terje Ogden
- Norwegian Centre for Child Behavioural Development, Unirand, Majorstuen, Box 7053 0368 Oslo, Norway
- Institute of Psychology, University of Oslo, Blindern, Box 1171, 0318 Oslo, Norway
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