An Evidence-Based Practice Developed in-situ: Let's Talk About Children and a Consolidation of Its Evidence Base

Sustaining efforts to improve family well-being with parents with mental ill health and substance (mis)use

Research conducted over the past 30 years has developed an extensive body of knowledge on families where parents experience mental ill health and/or substance (mis)use, and interventions that are effective in improving their outcomes. A more recent focus has also explored the importance and nuance of implementation. This perspective article reflects on the concept and practice of sustainability within this body of work and considers underlying assumptions in the field about the goal and direction of interventions that make clarity about sustainability difficult. We identify challenges for understanding sustainability, relating to how and who defines it, what is measured and the impact of context. We conclude by considering how we might be better able to plan and design for sustainability within this field.

'Let's Talk About Children' family focused practice for children of parents with schizophrenia and bipolar disorder: protocol for a randomized controlled trial

INTRODUCTION

'Let's Talk About Children' is a brief family focused intervention developed to improve mental health outcomes of children of parents with mental illness (COPMI). This study aims to assess the efficacy of LTC in improving mental health of children of parents with schizophrenia or bipolar disorder in China.

METHODS

The planned study is a multicentre parallel group randomized wait-list controlled trial. A total of 400 eligible families with children aged 8 to 18 years will be recruited, 200 each for families with parental schizophrenia or bipolar disorder. The intervention group will receive Let's Talk About Children delivered by a trained therapist, while the control group will receive treatment as usual. The primary outcomes are child mental health measured by the strengths and difficulties questionnaire and parent-child communication measured using the parent-adolescent communication scale. Parental mental health and family functioning are secondary outcomes. This study also plans to explore mediating factors for the effect of Let's Talk About Children on child mental health, as well as conduct a cost-effectiveness analysis on using Let's Talk About Children in China.

CONCLUSION

The present study will provide evidence for the efficacy of Let's Talk About Children in families with parental schizophrenia and bipolar disorder in China. In addition, it will evaluate potential mechanisms of action and cost-effectiveness of Let's Talk About Children, providing a basis for future implementation.

TRIAL REGISTRATION

ChiCTR2300073904.

The "Let's Talk about Children" intervention in a Finnish school context: fidelity, parents' experiences, and perceived benefits

The Let's Talk about Children intervention is a tool for parents and professionals to work together to promote children's positive development, resilience, and psychosocial well-being in social and healthcare services, at school, and in day care. The aim of this study was to evaluate the fidelity, parents' experiences, and perceived benefits of using the Let's Talk about Children intervention in a school context. Participants (N = 65 first-grader parents) completed an online questionnaire after the intervention. The results show that the intervention was delivered as designed and conducted with high fidelity. Parents' experiences of the Let's Talk about Children discussions were positive, parents felt that the atmosphere was good during the discussion, and the participants reported benefits from the intervention. Clinical trial registration:ClinicalTrials.gov, identifier NCT05038280.

The ParentingWell Practice Approach: Adaptation of Let's Talk About Children for Parents With Mental Illness in Adult Mental Health Services in the United States

Background

Despite the importance of family and parent-focused practice, there has been a dearth of research on interventions for parents with mental illness. This paper describes the process and outcome of adapting an evidence-based intervention, Let's Talk about Children (LTC), in the context of adult mental health services in Massachusetts, United States.

Methods

Specific objectives included: (1) to specify the core components, functions, and principles of LTC essential to adapting the intervention (i.e., program theory), (2) to consider contextual factors related to the new setting; (3) to pre-test the adapted materials with diverse practitioners; and (4) to compile the program model and materials (i.e., the practice profile) for use by adult mental health service providers in Massachusetts. The Adaptation Team included individuals with expertise in psychiatric rehabilitation and clinical care, policymaking, program development and research, and parents. Activities occurred between 2015-2019 and included: (1) consulting with experts to specify the core elements and theory behind the selected intervention (i.e., with the LTC purveyor and international experts); (2) consulting with key stakeholders for input regarding the Massachusetts target population and context to inform adaptations (i.e., individual and group key informant interview sessions); (3) pretesting the initial adapted materials (i.e., training and coaching sessions with adult mental health practitioners); and (4) using feedback to refine and compile the final intervention manual (i.e., the ParentingWell Practice Profile). Participants reflected diverse, oftentimes multiple roles and perspectives, including those of parents with mental illness, adult children, and family members.

Results

ParentingWell is practitioner- and setting-agnostic, addresses parenting across the lifespan, fits into the routine workflow, and builds on practitioners' existing skills. Eight themes emerged, which were translated into four core elements (engage, explore, plan, access and advocate) consistent with Self-Determination Theory and four underlying principles (trauma-informed, strengths-based, family-focused, culturally sensitive) in keeping with the LTC model. The ParentingWell Practice Profile operationalizes each core element and addresses the underlying principles.

Conclusion

ParentingWell makes talking about parenting and family experiences a routine part of the therapeutic conversation with adults with mental illness. Future research will test the adaptation, implementation, and impact of ParentingWell.