Melinda Goodyear

A role for aquaporin-4 in fluid regulation in the inner retina

Many diverse retinal disorders are characterized by retinal edema; yet, little experimental attention has been given to understanding the fundamental mechanisms underlying and contributing to these fluid-based disorders. Water transport in and out of cells is achieved by specialized membrane channels, with most rapid water transport regulated by transmembrane water channels known as aquaporins (AQPs). The predominant AQP in the mammalian retina is AQP4, which is expressed on the Müller glial cells. Müller cells have previously been shown to modulate neuronal activity by modifying the concentrations of ions, neurotransmitters, and other neuroactive substances within the extracellular space between the inner and the outer limiting membrane. In doing so, Müller cells maintain extracellular homeostasis, especially with regard to the spatial buffering of extracellular potassium (K+) via inward rectifying K+ channels (Kir channels). Recent studies of water transport and the spatial buffering of K+ through glial cells have highlighted the involvement of both AQP4 and Kir channels in regulating the extracellular environment in the brain and retina. As both glial functions are associated with neuronal activation, controversy exists in the literature as to whether the relationship is functionally dependent. It is argued in this review that as AQP4 channels are likely to be the conduit for facilitating fluid homeostasis in the inner retina during light activation, AQP4 channels are also likely to play a consequent role in the regulation of ocular volume and growth. Recent research has already shown that the level of AQP4 expression is associated with environmentally driven manipulations of light activity on the retina and the development of myopia.

Standards of practice for the adult mental health workforce: meeting the needs of families where a parent has a mental illness.

This article outlines the development of practice standards for the adult mental health workforce for addressing the needs of families where a parent has a mental illness (FaPMI). The practice standards recommended here were formulated using a modified cooperative inquiry process with a group of senior clinical leaders in adult mental health services in Australia, following consultation with the available literature and policy documents. The aim of the project was to generate, align, and operationalize family-inclusive practice standards within the core activities of the adult mental health workforce and integrate into the continuum of care and recovery for service users who are parents of dependent children. As part of a modified Delphi method, the standards were also ranked by the senior clinical leaders to determine what they believe to be essential and recommended practices for the adult mental health workforce they manage. We argue that developing practice standards that provide practical and realistic expectations of the adult mental health service workforce enable services and workers to better adapt practice to respond to FaPMI.

The family-focused mental health practice questionnaire.

It is estimated that 1 in 5 children have a parent with a mental illness, and studies have shown that such children are more likely to develop mental health problems when compared with their peers. Research has demonstrated the benefits of mental health clinician family-sensitive practice to both parents and their children; however, a measure of clinician practice is not available. The psychometric properties of a questionnaire measuring family-focused practice in the psychiatric setting are reported here. There were 307 public adult mental health worker participants, predominantly from the nursing profession and working full time. Principal component analysis highlighted 14 subscales that summarize 49 items reflecting organizational and worker factors, such as skill/knowledge about the impact of parental mental illness on children and worker confidence. Subscales are discussed in relation to the literature and psychiatric policy. The measure appears a useful tool for evaluation, benchmarking for training and organizational improvement, and ultimately, for increasing quality services to parents, families, and particularly children associated with psychiatric services.

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross-sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.

CHAMPS: A peer support program for children of parents with a mental illness

Abstract Having a parent with a mental illness can create considerable risks in the mental health and wellbeing of children. While intervention programs have been used effectively to reduce children’s psychopathology, particularly those whose parents have a specific diagnosis, little is known about the effectiveness of these early interventions for the wellbeing of children of parents who have a mental illness from a broad range of parents. Here we report on an evaluation of CHAMPS (Children And Mentally ill ParentS), a pilot intervention program offered in two formats (school holiday and after school peer support programs) to children aged 8–12 whose parents have a mental illness. The wellbeing of 69 children was evaluated at the beginning of the programs and four weeks after program completion, on instruments examining self-esteem, coping skills, connections (total, within and outside the family) and relationship problems (total, within and outside the family). Post intervention, there were significant improvements in self-esteem, coping and connections within the family, and reductions in relationship problems. The impact on children’s wellbeing differed according to the intensity of the program (consecutive days or weekly program). The results are discussed in the context of providing interventions for children whose parents have a mental illness and the implications for service provision generally.

Investigating the Strengths and Difficulties of Children from Families with a Parental Mental Illness

Abstract This study investigated whether two groups of children from families with a parent with a mental illness were different to a normative group of children (no parental illness) on the Strengths and Difficulties Questionnaire (SDQ). Of the total 833 children aged 8-12 years, there were 101 children of parents with a mental illness from the general community, 134 children of parents with a mental illness who attended an intervention program and a normative sample of 598. The intervention group scored significantly higher than the other groups on all difficulties. In addition, the general community group with a parental illness scored significantly higher than those without a parental mental illness on the Total Difficulties, Emotional Symptoms and Hyperactivity subscales. These were important findings as the community and intervention children with a parent with a mental illness scored at two and three times respectively the normative level of risk to their mental health. Combined with previous risk estimates, children with a parent who attend mental health services are between two to five times more likely than the norm to be scoring in the clinical range on the SDQ. Recommendations are made regarding child morbidity, mental health policy, programs, workforce and future research.

Australian programs and workforce initiatives for children and their families where a parent has a mental illness

Abstract The aim of this study was to review the child, parent and family programs and workforce initiatives in Australia that target children and families where a parent has a mental illness. Fifty two individual telephone interviews were conducted with facilitators responsible for 60 child, parent, family and workforce programs across Australia. Interviewees were asked to describe (i) the program provided, (ii) the evidence framework of the program, and (iii) evaluation strategies employed. To supplement this data, three consumers and one carer were interviewed regarding their involvement in programs. Participants were identified through websites, e-discussion lists and snowball recruiting. Audio transcripts from the interviews were qualitatively analysed, using thematic analysis, alongside inter-rater reliability and member checks. Of the 60 identified programs, there were 26 child and adolescent programs, six programs for parents with a mental illness, four family programs and 24 workforce training initiatives. Program facilitators typically drew on their clinical experiences, rather than research, when developing programs. Generally, evaluation strategies were non standardised and/or measured participant satisfaction of programs. There was no systematic way of involving and supporting consumers and carers. Recommendations are made regarding evaluation training, a participation framework for consumers and carers, funding for programs, and the establishment of a formal network for sharing resources and facilitator experiences.

Family resilience in families where a parent has a mental illness

Summary This study explores the concept of family resilience where a parent has a mental illness. Eleven Australian adults who have grown up in a household with a parent who had a diagnosed mental illness participated in an in-depth interview. The interviews focused on the ways in which these families responded to challenges in everyday life, particularly related to parental mental illness. Findings Families developed resilience through processes such as shared humour or regular family rituals and routines. In some cases, open communication about mental illness enabled families to better cope when parents were unwell and to build a greater sense of family connectedness. However, data suggest that parental mental illness potentially creates stress and confusion for families and there are multiple social and cultural barriers that make it difficult for families to acknowledge and speak openly about mental illness. For participants, resilience tended to be about maintaining a balance between stress/distress and optimism and strength within their family. Applications The article highlights the importance of family context when describing resilience, and identifies specific clinical implications for working with families affected by parental mental illness.

Worker, workplace or families: What influences family focused practices in adult mental health?

UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Family focused practice leads to positive outcomes for parents and children. There are barriers and enablers for practitioners being family focused. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Worker skill, knowledge and confidence about family work are the most important factors associated with family focused practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses require specific skill training in family focused practices, time to engage with clients on parenting issues and that there are adequate services to refer family members to. ABSTRACT Introduction Family focused practice is thought to lead to positive outcomes for all family members. However, there are multiple barriers and enablers in adult mental health services to practitioners undertaking these actions. Aim The aim of this study was to examine the relative importance of worker, workforce and family factors to predict family focused practices (FFPs) in adult mental health services. Method Three hundred and seven adult mental health workers completed a 45 items family focused practice measure of 16 family focused practices. Thesis It was found that worker skill and knowledge about family work and an ability to assess the degree of parental insight into the childs connections to other family members and the community were important predictors of FFP, along with the closely related-worker confidence. While aspects of the worker, workplace and family each contribute to FFPs, this study highlighted the importance of worker skill, knowledge and confidence as central issues for adult mental health workers. Implications for practice Study implications include the need for training in specific FFPs, the provision of time to engage with clients on parenting issues and the need 5 to ensure that there are adequate services for workers to refer family members to.

Goal setting within family care planning: families with complex needs

Objective: To identify the key goals that are established by children and parents from families in which parents have substance use and/or mental health problems, and the level of progress achieved towards goals over 1 year of case management.