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Øverhaug OMS, Laue J, Vis SA, Risør MB. 'There's a will, but not a way': Norwegian GPs' experiences of collaboration with child welfare services - a grounded theory study. BMC PRIMARY CARE 2024; 25:36. [PMID: 38267870 PMCID: PMC10807144 DOI: 10.1186/s12875-024-02269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Adverse childhood experiences can have immediate effects on a child's wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services. The aim of this study is to explore GPs' experiences of the collaboration process with child welfare services. METHOD This is a qualitative grounded theory study, with data consisting of ten semi-structured interviews with general practitioners across Norway. RESULTS The doctors' main concern was: 'There's a will, but not a way'. Three subordinate stages of the collaboration process were identified: (I) Familiar territory, with a whole-person approach to care by the doctor. (II) Unfamiliar territory, when child welfare becomes involved. Here, a one-way window of information and a closed door to dialogue perpetuate the doctors' lack of knowledge about child welfare services and uncertainty about what is happening to their patients. (III) Fragmented territory, where doctors experience lost opportunities to help and missing pieces in the patient's history. CONCLUSION General practitioners are willing to contribute to a collaborative process with child welfare, but this is hampered by factors such as poor information flow and opportunities for dialogue, and limited knowledge of the partner. This implies lost opportunities for doctors to help families and contribute their knowledge and potential actions to a child welfare case. It can also impede whole-person care and lead to fragmentation of patient pathways. To counteract this, electronic two-way communication could enable a collaborative process and relationships that enhance coordination between the parties. Making space for all parties and their individual roles was considered important to create a positive collaborative environment.
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Affiliation(s)
| | - Johanna Laue
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Svein Arild Vis
- Regional Centre for Child and Youth Mental Health & Child Welfare, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Mette Bech Risør
- Department of Community Medicine, The General Practice Research Unit, UiT The Arctic University of Norway, Tromsø, Norway
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ribette C, Rosenthal L, Raynaud JP, Franchitto L, Revet A. Primary care physicians' experience of caring for children with parents with mental health illness: a qualitative study among French general practitioners and paediatricians. BMC PRIMARY CARE 2023; 24:190. [PMID: 37718455 PMCID: PMC10506299 DOI: 10.1186/s12875-023-02145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Parental psychiatric disorders can have a significant impact on child development and the parent-infant bond, with a high risk of attachment disorders. Early identification of difficulties in the parent-child relationship is essential to prevent consequences for the child. Childcare practitioners have a major role to play in this early detection process, through regular mandatory consultations during the first two years of a child's life. Thus, the aim of this study was to collect the experience of private practitioners in their care of children of parents with a mental health illness. METHOD This is a cross-sectional, observational, qualitative study. Data were collected by means of semi-structured interviews with eleven general practitioners and private paediatricians between February and July 2021 in Toulouse and its suburbs. We only included practitioners who had followed children of parents with a mental health illness. The interviews were recorded with the agreement of the participants, before being transcribed anonymously. The data were analysed with NVivo software using interpretative phenomenological analysis. RESULTS Three main themes emerged from the results, which were further divided into several sub-themes. Addressing psychiatric disorders presents a risk for the therapeutic relationship. Practitioners express a need to preserve this relationship with the parent in joint care. Care is difficult and is permeated by the parents' emotional issues. Furthermore, practitioners face a conflict between their concerns for the parent-child bond and their desire not to stigmatise these families. They express a feeling of isolation in these follow-ups. This stressful care has a significant emotional impact on the doctors. Access to psychiatric training and multidisciplinary collaboration seem to be essential to improve the follow-up experience for practitioners, as these factors strengthen inter-professional connections. CONCLUSION Practitioners describe a parent-doctor relationship at risk, which is underpinned by the fear of care placement. This study illustrates the need to strengthen multidisciplinary work by promoting interprofessional exchanges, in order to improve the experience of practitioners in this care process. Addressing practitioners' fear of discussing parental psychiatric illness is very important, so as not to delay the implementation of preventive actions that are likely to improve the developmental prognosis for children.
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Affiliation(s)
- Cécile Ribette
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France.
| | - Lucie Rosenthal
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Raynaud
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Ludivine Franchitto
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
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Mao P, Long N, Xie W, Yan F, Chen Y, Peng L. Progress in qualitative study on mental health service demand of children and adolescents with adverse childhood experiences. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1163-1170. [PMID: 36097785 PMCID: PMC10950102 DOI: 10.11817/j.issn.1672-7347.2022.210783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 06/15/2023]
Abstract
As a global public health problem, adverse childhood experiences (ACEs) is an important factor leading to serious psychological and behavioral problems in children and adolescents. Mental health service plan based on mental health service needs is the key to effectively improve the psychological problems of children and adolescents with ACEs. Emotional support, life skills training, mental health education, and individualized psychological intervention can effectively improve the mental health of children and adolescents with ACEs. Among them, emotional support is an important way to help individual reduce psychological and behavioral problems; secondly, life skills training can significantly improve the individual's psychosocial ability; and mental health education is a necessary way to promote the development of individual mental health. Individualized psychological intervention can promote individual to obtain more professional mental health service and improve their psychological symptoms, which is crucial for preventing the occurrence of mental health problems. Future research can develop targeted mental health interventions based on the specific mental health service needs.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
- Hunan Key Laboratory of Nursing, Changsha 410013.
| | - Nannan Long
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
- Xiangya School of Nursing, Central South University, Changsha 410013
| | - Wenzhao Xie
- Key Laboratory of Medical Information Research in Colleges and Universities of Hunan Province, Changsha 410013
| | - Fang Yan
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Yang Chen
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Lianhua Peng
- Clinical Medical Research Center, Affiliated Hospital of Jinggangshan University, Ji'an Jiangxi 343000, China.
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Oja C, Edbom T, Nager A, Månsson J, Ekblad S. Awareness of parental illness: a grounded theory of upholding family equilibrium in parents on long-term sick-leave in primary health care. Scand J Prim Health Care 2021; 39:268-278. [PMID: 34152244 PMCID: PMC8477794 DOI: 10.1080/02813432.2021.1928835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE To understand the main concern of chronically ill parents and how they resolve this concern in relation to their children. DESIGN Grounded theory. SETTING Three primary health care clinics in Sweden. SUBJECTS Thirty-two interviewed parents and their children. MAIN OUTCOME MEASURES Processes and typologies of upholding family relationships. RESULTS A concern of chronically ill parents is sustaining family equilibrium, achieved through a process of upholding family relationships. How a parent upholds depends upon his/her comprehension of the illness and of their child's need for parenting. In response to the parent's upholding behaviours, children mirror the effect of the illness to the parent, the child's specific behaviour depending on his/her level of comprehension regarding the parent's illness. Their combined behaviours create an awareness context that may be closed, concealed, suspicious, conflicted, mutual pretence or open.When the parent drives and facilitates the evolution of comprehension, the context quickly evolves from closed to open. When the parent hinders the process by masking and resisting the child responds by probing and proving and they become locked into a suspicious or conflicted awareness context with high relational tension. To create family equilibrium the parent needs to reveal and facilitate the awareness process. CONCLUSION Parents on long-term sick leave in primary health care can need assistance to facilitate the awareness context of themselves and their child.Implications: Clinicians can identify the current awareness context of their patient and help their patient towards increased understanding of their illness; their child's needs and the parental capacities needed to reveal the illness and its impacts.Key PointsChildren are affected when parents are ill; they wish for information on their parent's illness. Effective interventions are available in settings other than primary health care and possibilities seen by GPs and families in Scandinavian primary health care have been previously described. There is a knowledge gap in how parents view themselves and their parenting when ill in primary health care. An analysis grounded in interviews was needed to generate a hypothesis (theory) of parental concerns and behaviours.This theory proposes that an important concern of chronically ill parents is to sustain family equilibrium, which they attempt to do by upholding family relationships.Specific upholding behaviours include masking, resisting, colluding, and revealing. In response, children will engage in mirroring behaviours. Which paired behaviours are enacted will depend upon the respective levels of comprehension of parent and child regarding the illness and on the child's need for parenting. In their interactions, parent and child create one of six awareness contexts.Identifying the current awareness context in the family about chronic parental illness provides clinicians with a conceptual tool to better support those families locked in suspicious or conflicted awareness contexts.
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Affiliation(s)
- Charlotte Oja
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- CONTACT Charlotte Oja Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Edbom
- Department of Clinical Neuroscience (CNS), Center for Psychiatric Research, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nager
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Solvig Ekblad
- Academic Primary Health Care Center, Region Stockholm, SLSO, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Cultural Medicine, Karolinska Institutet, Stockholm, Sweden
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Woodman J, Simon A, Hauari H, Gilbert R. A scoping review of 'think-family' approaches in healthcare settings. J Public Health (Oxf) 2021; 42:21-37. [PMID: 30668870 DOI: 10.1093/pubmed/fdy210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND 'Think-family' child health approaches treat child and parent/carer health as inter-related. They are promoted within health policy internationally (also called 'family paediatrics' or 'whole-family', 'family-centred' approaches or 'child-centred' approaches within adult services). METHODS We reviewed publications of think-family interventions. We developed a typology of these interventions using thematic analysis of data extracted from the included studies. RESULTS We included 62 studies (60% USA and 18% UK); 45/62 (73%) treated the parent as patient, helping the child by addressing parental mental health, substance and alcohol misuse and/or domestic violence. Our typology details three common mechanisms of change in relevant interventions: screening, health promotion and developing relationships (inter-professional and parent-professional). CONCLUSIONS Policy-makers, practitioners and researchers can use our typology to develop and evaluate think-family approaches within healthcare. Strong relationships between parents and professionals are key in think-family approaches and should be considered in service design. Although helping the child through the parent may be a good place to start for service development, care is needed to ensure parental need does not eclipse child need. Strategies that reach out to the parent behind the child (child as patient) and which work simultaneously with parent and child warrant attention.
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Affiliation(s)
- Jenny Woodman
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Antonia Simon
- UCL-Institute of Education, Social Science Research Unit, 27/8 Woburn Square, London, UK
| | - Hanan Hauari
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Ruth Gilbert
- UCL-GOS- Institute of Child Health, 30 Guilford Street, London, UK
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Perruci LG, Diehl A, da Silveira BV, Teixeira JA, Souza J, Miasso AI, Dos Santos PL, Dos Santos MA, de Souza RM, Pillon SC, Wagstaff C. The emotional and psychiatric problems of adolescents on parole whose parents are substance users: A Brazilian cross-sectional study. J Child Health Care 2021; 25:253-267. [PMID: 32394746 DOI: 10.1177/1367493520925661] [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] [Indexed: 11/16/2022]
Abstract
The aim of this study is to evaluate the associations between having parents with substance use problems, and having suffered neglect within the family, and behavioral problems (psychological and drug use) among adolescents. All the participants were enrolled on the socio-educational parole scheme, 'Assisted Freedom'. In this cross-sectional study, 150 adolescents were interviewed using the Drug Abuse Screening Test, Teen Addiction Severity Index, and Childhood Trauma Questionnaire. Ninety-five percent of the participants were male (n = 143), aged 13-17. Thirty percent of adolescents had a parent who used substances and had experienced neglect from their families. Those adolescents who were living with both parents (odds ratio adjusted (ORA) = 2.7, 95% confidence interval (CI) = 1.13-6.37), from a low-income family (ORA = 6.7, 95% CI = 1.85-24.22), experienced hallucinations (ORA = 2.8, 95% CI = 1.25-6.14), had problems controlling violent behavior (ORA = 2.6, 95% CI = 1.12-5.87), and were physically neglected (ORA = 3.0, 95% CI = 1.24-7.49) were more likely to have parents who used substances and to have experienced parental neglect. This article concludes that adolescents, who are on parole, come from families with high level of psychosocial vulnerabilities, including substance use, experience neglect by their families leading to adverse emotional and psychological states.
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Affiliation(s)
- Ludmila Gonçalves Perruci
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
| | - Alessandra Diehl
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Belisa Vieira da Silveira
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
| | - Jessica Adrielle Teixeira
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
| | - Jacqueline Souza
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
| | - Adriana Inocenti Miasso
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
| | - Patricia Leila Dos Santos
- Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo (USP), São Paulo, Brazil
| | - Manoel Antônio Dos Santos
- Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo (USP), São Paulo, Brazil
| | - Roberto Molina de Souza
- Academic Department of Mathematics (DAMAT), Federal Technological University of Paraná, Paraná, Brazil
| | - Sandra Cristina Pillon
- PAHO/WHO Collaborating Centre for Nursing Research Development, Department of Psychiatric Nursing and Human Science, Faculty of Nursing at Ribeirão Preto (EERP), University of São Paulo (USP), São Paulo, Brazil
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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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Hafting M, Gullbrå F, Anderssen N, Rørtveit G, Smith-Sivertsen T, Malterud K. Burdened parents sharing their concerns for their children with the doctor. The impact of trust in general practice: a qualitative study. Scand J Prim Health Care 2019; 37:327-334. [PMID: 31309855 PMCID: PMC6713169 DOI: 10.1080/02813432.2019.1639907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The aim of this study was to recognise the preconditions experienced by general practitioners (GPs) in addressing the children's needs when ill and substance abusing parents consult for their own health problems. Design: Qualitative analysis of 38 case stories told by GPs in focus group interviews. Setting: Focus group interviews of four continuing medical education groups for GPs in western Norway. Subjects: 27 GPs (nine females) with at least 5 years' experiences in general practice. Results: Different aspects of the GPs' perceived mandate of trust from the parents was a precondition for the children's situation to be addressed. In some case stories the participants took an open mandate from the parent for granted, while in others they assumed that the parent did not want to discuss their family situation. Sometimes the participants had faith that by continuing with their ordinary GP tasks, they might obtain a more open mandate of trust. Their evaluation of the mandate of trust seemed to impact on how the GP could adopt a mediating role between the parents and various support agencies, thus supporting children who were at risk. Discussion/conclusion: The children most at risk may remain invisible in GPs' encounters with their parents, possibly because their parent's health problems and overall situation overshadow the children's situation. The mandate of trust from burdened parents to GPs can be a fruitful concept in understanding the interaction regarding the welfare of the parent's children. Negotiating the mandate of trust with parents by explicitly addressing trust and having an ongoing discussion about the mandate and its limits might be an option to secure the children support if necessary. KEY POINTS Offering children of burdened parents information and support can be crucial for health promotion and illness prevention. A general practitioner's (GP's) evaluation of the trust parents have in them can determine the extent of support children receive. Depending on the parents' level of trust, GPs may take a mediating role between support services and parents for the benefit of the children. A negotiation concerning the trust parents have in the GP may open up possibilities for GPs to offer children necessary support.
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Affiliation(s)
- Marit Hafting
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway;
- CONTACT Marit Hafting Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway
| | - Frøydis Gullbrå
- Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway;
| | - Norman Anderssen
- Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway;
- Department of Psychosocial Science, University of Bergen, Bergen, Norway;
| | - Guri Rørtveit
- Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway;
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Tone Smith-Sivertsen
- Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway;
| | - Kirsti Malterud
- Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway;
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hafting M, Gullbrå F, Anderssen N, Rørtveit G, Smith-Sivertsen T, van Doesum K. Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse. Front Psychiatry 2019; 9:724. [PMID: 30670986 PMCID: PMC6331400 DOI: 10.3389/fpsyt.2018.00724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/07/2018] [Indexed: 12/03/2022] Open
Abstract
Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.
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Affiliation(s)
- Marit Hafting
- Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Guri Rørtveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Karin van Doesum
- Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Impluz, Prevention Team Mental Health, Deventer, Netherlands
- Regional Center of Child and Youth Mental Health and Child Welfare, Artic University of Tromsø, Tromsø, Norway
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Oja C, Edbom T, Nager A, Månsson J, Ekblad S. Making life work for both themselves and their parents alone- how children aged 11–16 view themselves in relation to their chronically ill parents in a primary health care setting. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2018. [DOI: 10.1080/02673843.2018.1548360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Charlotte Oja
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Tobias Edbom
- Department of Clinical Neuroscience (CNS), Center for Psychiatric Research, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Anna Nager
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Solvig Ekblad
- Academic Primary Health Care, Stockholm County Council, Stockholm
- Department of Learning, Informatics, Management and Ethics (LIME), Culture Medicine, Karolinska Institutet, Stockholm, Sweden
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