Are we starting to ‘think family’? evidence from a case file audit of parents and children supported by mental health, addictions and children's services

Globally, it is estimated that anywhere between 12 and 45 per cent of adults receiving mental health treatment are parents and up to one quarter of the child population lives with at least one parent with a mental health problem (Reupert & Maybery, 16). While the impact on parenting varies across the wide spectrum of mental health and substance use problems, many children will experience cognitive, emotional, social, physical and behavioural issues, and they will be exposed to other commonly associated stressors such as poverty, isolation, instability and stigma that can negatively affect family life (Royal College of Psychiatrists, 17).Northern Ireland has the highest prevalence of parent mental health problems in the UK, with similarly elevated rates in the child and adolescent populations (Abel et al., 1; Bunting et al., 4). Recent research found that children in Northern Ireland were twice as likely to have an anxiety or depressive disorder if their parent reported mental health problems themselves (Bunting et al., 4).Family-focused practice (FFP) provides support to a service user by acknowledging the context of their family relationships and endeavours to meet the needs of the whole family (Lagdon et al., 13). FFP can be beneficial for the whole family when parents have mental health and substance use problems (Cooper & Reupert, 6). The type and intensity of activities/processes may be influenced by the professional discipline, service type and beliefs about FFP (Maybery et al., 14). However, staff may work in isolation from other disciplines, guarding their professional territory amid fear of trespass, particularly if another service is seen as ‘responsible’ (Baistow & Hetherington, 3; Cowling & Garrett, 7). Uncertainty over professional responsibility for children where parental mental health problems are a concern has created tension within the social work profession, where perceptions of hierarchy can prioritise one service (child protection) above another (mental health/addictions) (Aldridge, 2; Coates, 5; Stanley et al., 18). Professional training in FFP has been limited with evidence of a skills deficit in practice, and parents can find it difficult engaging with services because of their mental health and associated fear, stigma and shame (Cowling & Garrett, 7; Grant et al., 11).The Northern Ireland Think Family initiative represents a strategic effort to promote FFP within adult mental health and children's services, in order to improve collaborative working and information-sharing to help families achieve greater access to early intervention and family support services (Donaghy, 9). Think Family has resulted in a range of regional and local initiatives to improve assessment, planning and intervention. These include: the development of a joint protocol to provide clear guidance on service response and promote interagency collaboration; the revision of adult mental health screening and assessment tools; specialised training; and the introduction of Think Family Champions to promote joint working across services (Falkov, 10). Specialist Think Family social work roles have been created to work alongside established Hidden Harm social workers, providing support for parents and families with dual mental health and substance use problems

Families with Parental Mental Health Problems: A Systematic Narrative Review of Family Focused Practice

The mental health problems of parents can negatively affect their whole family. The organisational and wider context may also influence the outcomes for all involved. The aims of this systematic review were: to develop a working definition of family-focused practice (FFP); identify the types of outcomes that are measured with a focus on service user experiences; and explore how well interventions in the included studies fit with previously established components of FFP. A comprehensive literature search of 16 databases was conducted for peer-reviewed, primary research studies related to FFP published between 1998 and 2016. In total, 3731 articles were identified and screened by four reviewers. Of those, 40 articles met all of the inclusion criteria. The review focused on family outcomes and, consistent with previous reviews, there was a reasonable degree of consistency about the core components of FFP. An additional component, identified by this review, which was part of some interventions, was work to improve access to and engagement with community supports and services. The review concludes that there is a need for: an agreed definition of FFP; clearer links to relevant theories; a more consistent approach to measuring outcomes, including economic perspectives; and an increased strategic promotion of whole family approaches

Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways

Validation of Next Generation Sequencing Technologies in Comparison to Current Diagnostic Gold Standards for BRAF, EGFR and KRAS Mutational Analysis

10.1371/journal.pone.0069604PLoS ONE87-POLN

Validation of the family focused mental health practice questionnaire in measuring health and social care professionals' family focused practice.

BackgroundParental 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.ObjectivesTo explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals.MethodsHealth 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.ResultsExploratory 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.ConclusionThis 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

Advances in EMI and GPR Algorithms in Discrimination Mode Processing for Handheld Landmine Detectors

This paper presents some advancement in the detection algorithms using EMI sensor, GPR sensor and their fusion. In the EMI algorithm, we propose the application of the weighted distributed density (WDD) functions on the wavelet domain and the time domain of the EMI data for feature based detection. A multilayer perceptron technique is then applied to discriminate between mine and clutter objects based on the wavelet domain and time domain features separately. When the results from the two domains are fused together, the probability of false alarms is reduced by a factor of two. The enhancement in the GPR algorithm includes the depth processing which selects a certain data segment below the ground surface for detection, as well as utilizing the phase variation of the signal return across a mine to achieve better detection. Finally, we present fusion results from EMI and GPR sensors to demonstrate that the two sensors provide complementary information and when they are properly fused together the probability of false alarm can be reduced significantly

Land Mine and Clutter Object Discrimination using Wavelet and Time Domain Spatially Distributed Features from Metal Detectors and their Fusion with GPR Features for Hand-Held Units

This paper presents some advances in discrimination and fusion algorithms using metal detector (MD) and ground penetrating radar (GPR) sensors in a robotic wand unit. Previously investigated spatially distributed features are extended and fused with discrete wavelet transform representations of MD data. A multilayer perceptron technique is then applied to discriminate between land mine and land mine-like objects based on the wavelet coefficient and time domain features separately. Using MD wavelet and time domain fusion, the probability of false alarms is reduced by 46.0% and 18.0% over the wavelet and time domain models, respectively, at 0.95 probability of detection. Fusion results are presented for the MD and GPR sensors to demonstrate that the two sensors provide complementary information for significantly reducing the probability of false alarm. Blind test results from a government test facility are presented to evaluate the effectiveness of the algorithms