Camilla Lauritzen

Implementing new routines in adult mental health care to identify and support children of mentally ill parents

BackgroundMental health problems are often transmitted from one generation to the next. This knowledge has led to changes in Norwegian legislation, making it mandatory to assess whether or not patients have children, and to provide necessary support for the children of mentally ill patients. The main purpose of this study was to evaluate the process of implementing new routines in adult mental health services to identify and support children of mentally ill parents.MethodsThe design was a pre-test post-test study. The sample (N = 219 at pre-test and N = 185 at post-test) included mental health professionals in the largest hospital in the region, who responded to a web-based survey on the routines of the services, attitudes within the workforce capacity, worker’s knowledge on the impact of parental mental illness on children, knowledge on legislation concerning children of patients, and demographic variables.ResultsThe results of this study indicated that some changes are taking place in clinical practice in terms of increased identification of children. Adult mental health services providing support for the children was however not fully implemented as a new practice.ConclusionThe main finding in this study is that the identification frequency had increased significantly according to self-reported data since the Family Assessment Form was implemented. The increase in self-reported identification behavior is however taking place very slowly. Three years after the legislation was changed to making it mandatory to assess whether or not patients have children, it was still not fully incorporated in the routines of the entire workforce. In terms of support for the families affected by parental mental illness, the changes are not yet significant.

Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their childrens needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients in the adult psychiatry of the University Hospital of Northern Norway. The project is designed to evaluate the process of changes in clinical practice due to the implementation of two interventions. The interventions to be implemented are a standardised Family Assessment Form and the intervention called Child Talks. The family assessment form is an intervention to identify children of mentally ill parents and their needs. The intervention Child Talks is a health-promoting and preventive intervention where the mental health workers talk with the family about the situation of the children and their needs. Methods/design There are two groups of participants in this study: (1) mental health workers in the clinic (N=220) and (2) patients who are parents (N=200) receiving treatment in the clinic. (1) In the evaluation of clinical practice, the authors use a pre-test, post-test and 1-year follow-up design. At pre-test, the authors evaluate status quo among mental health workers in the clinic regarding knowledge, attitudes, collaborative routines and clinical practice related to families with parental mental illness. After the pre-test is finished, the project move on to implement the interventions Family Assessment Form and Child Talks in the clinic. At post-test and 1-year follow-up, the authors evaluate the impact of implementing the Family Assessment Form in terms of how many children were identified and offered Child Talks in the clinic or referred to other services for additional support. (2) In the evaluation of parents/patients experience with the interventions, the authors use a pre-test post-test design. To identify children of mentally ill patients, the authors collect data on demographical variables for the patient and the child at pre-measures, as well as data on parental competence (PSOC) and parental concerns (PEDS) about their children. At post-measures, the authors evaluate the impact of the intervention in terms of user satisfaction, as well as changes between pre- and post-measures on parental competence (PSOC) and parental concerns (PEDS) about their children. Discussion The implication of implementing new interventions to safeguard children of mentally ill patients and the limitation of not measuring child development directly are discussed.

Translating Knowledge about Parental Mental Illness to the Field of Practice

Parental mental illness is a powerful risk factor, with a potential of serious impact for the children. Mental health problems are often transmitted from one generation to the next. Parental mental illness is however considered to be a malleable risk-factor, which means there are measures that can be taken to counteract the risk. Nevertheless, transferring this knowledge to the field of parental mental illness has been very difficult. The aim of the current study was to explore the relationship between knowledge and attitudes towards a child perspective in adult mental health services and actual clinical practice. The aim was furthermore to investigate which factors are hindering or promoting the translation of new knowledge to the field of practice. In the present study results will be interpreted in light of the theory of reasoned action.

Knowledge transfer in the field of parental mental illness: objectives, effective strategies, indicators of success, and sustainability

BackgroundMental health problems are often transmitted from one generation to the next. However, transferring knowledge about interventions that reduce intergenerational transmission of disease to the field of parental mental illness has been very difficult. One of the most critical issues in mental health services research is the gap between what is generally known about effective treatment and what is provided to consumers in routine care.DiscussionIn this article we discuss several aspects of knowledge transfer in the field of parental mental illness. Effective strategies and implementation prerequisites are explored, and we also discuss indicators of success and sustainability.SummaryAltogether, this article presents a rationale for the importance of preventive strategies for children of mentally ill parents. Furthermore, the discussion shows how complex it is to change clinical practice.

Successful recruitment strategies for prevention programs targeting children of parents with mental health challenges: An international study

AbSTRACT Research substantiates children of parents with mental disorders including substance abuse face increased risk for emotional and behavioral problems. Although evidence suggests that support programs for children enhance resiliency, recruiting children to these groups remains problematic. This study identifies successful recruitment strategies for prevention programs for children of parental mental illness. The participants were recruited from an international network of researchers. E-mail invitations requested that researchers forward a web-based questionnaire to five colleagues with recruitment experience. Forty-five individuals from nine countries practicing in mental health responded. Descriptive statistics and qualitative content analysis techniques were used. Results: Schools, adult, and youth mental health services were recruitment sources. Nine themes were identified: Relationships, diversified information output, logistics, program consistency, family involvement, recruitment through adults, stigma, recruiting locations, social media. Recruitment barriers were: stigma, inadequate knowledge about parental mental illness and limited time. Transportation to programming was an essential component of successful recruitment.

Factors that determine decision making in child protection investigations: A review of the literature

Child & Family Social Work. 2018;23:743–756. Abstract The aim of the studywas to conduct a systematic review of the literature on factors that determine decision making in child protection investigations. More specifically, to investigate the existing research on the 4 factors that are considered fundamental for child protection decision making: case characteristics, caseworker characteristics, organizational characteristics, and external factors. The results indicated that childwelfare decisions to investigate a case and/or to implement services are influenced by characteristics of the case, the social worker, and the organization, in addition to external factors. These elements work together to determine the outcome of an investigation. There are some substantial differences between various countries connected to disparities in child welfare legislation, support apparatuses, culture, ideology, and socio‐economic factors. It is methodologically challenging to design studies that capture all possible variables associated with case factors, social workers, and organizational factors. However, multilevel analyses of the types of variables that are most significant to case outcome conclude that caseworker assessments corresponded to organizational factors. Furthermore, decisions are better explained by characteristics of the child welfare organization than by characteristics of the social worker.

Parenting stress among Norwegian kinship and non-kinship foster parents

Abstract There are several studies conducted on parenting stress, and the conclusion in the parenting stress research literature is generally that parenting stress decreases the quality of the parent-child relationship. There are however few studies on parenting stress comparing kinship homes to ordinary types of foster homes. The aims of this study were to measure parenting stress in kinship and non-kinship foster homes and to explore factors that predict parenting stress related to the child and to their role as foster parents. Results show that kinship-foster parents experienced higher stress related to the parent domain i.e. depression and relationship problems with the spouse. This was associated with kinship foster parents being of older age and receiving fewer social support services. Non-kinship foster parents experienced higher parenting stress related to the child domain i.e. child’s acceptability and adaptability in the family. This was associated with children in non-kinship foster homes having higher internalising and externalising mental health problems. The implications are that different types of support are needed for kinship foster parents and non-kinship foster parents. More differentiated support for foster parents may help prevent parenting problems and increase placement permanency.

Establishing evidence-based practices within services for children: knowledge transfer challenges

Background Although more knowledge about effective interventions is frequently developed, most services in Norway are not evidence based. Part of the reason might be that practitioners and decision-makers do not know which interventions have scientific evidence for effectiveness and that they don’t search for information in traditional research literature. Although the evidence base of available interventions is growing, little research has been conducted on implementation strategies to bridge the gap between research and practice.