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

Background: Mental 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. Discussion: In 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. Summary: Altogether, 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

Screening decisions for non-abuse concerns reported to child protection agencies- a structural equation model for referral content and decision outcome

Objectives: Child protection referrals that contain information about incidents of physical child abuse, sexual abuse, and domestic violence have a high chance of being screened in for investigation. The aim of the current study is to investigate which case factors that affect the decision to screen-in cases with other types of concerns. Method: A sample of referrals (N = 1365) to child protection services in Norway was randomly drawn. Information was collected regarding (i) child and family characteristics, (ii) the content of the referral (iii) the decision to investigate. A structural equation model that describe how case characteristics and the contents of the report influence the screening decision was estimated. Results: Non abuse-concerns were grouped in three latent variables. The first consisted of referrals that contained concerns about a wide range of problems related to the child’s health and development. The second consisted of referrals that contained concerns about parental conflicts and child safety. The third consisted of concerns related to different types of family and environmental risk factors. Families with immigrant background have an increased chance of being screened-in, irrespective of referral content. Cases with previous referrals have a decreased chance of being screened-in. Conclusions: When controlling for other case factors, more complex referrals with multiple concerns have increased chance of being screened in

Child-focused practice in social services for adults in Norway

Summary - Children of social service users are at risk for developing mental health problems as well as social and behavioral problems. Social service counselors should therefore be aware of service users’ children and provide support for them. In fact, they are obligated by law to consider children's views and their best interests in cases affecting them. Despite this, little is known about social service counselors’ child focus in their practice. In this study, self-reported survey data from 93 counselors working for the Norwegian Labor and Welfare Administration (NAV) were analyzed to explore their child focus. Findings - Findings suggest that a particular focus on children is no part of common practice among NAV counselors; nor is use or knowledge of The United Nations Convention on the Rights of the Child (CRC). Knowledge and use of the CRC may be a predictor of child-focused practice. The results showed a significant difference of medium effect size between NAV counselors who ask about children and NAV counselors who do not when it comes to knowledge and use of the CRC. Applications - Policy makers and practitioners should utilize NAV's potential as a preventive arena. For NAV counselors to be aware of and support children of social service users they need a stronger focus on children and hence know and use the laws concerning children's rights. Incorporating children's rights into social workers’ education and internal training may strengthen the focus on children in NAV counselors’ practice

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

Contains fulltext : 102515.pdf (publisher's version ) (Open Access)Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's 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.6 p

Veiledning for nyansatte i barnevernet

Accepted manuscript version. Published version available at https://www.idunn.no/tnb/2015/04Myndighetene ønsker å innføre veiledet førsteår for nyansatte i barnevernet, med hensikt om å redusere frafall, samt å bidra til profesjonell utvikling av nyansatte. Dette prosjektet hadde som formål å undersøke hvor langt man har kommet med å innføre veiledning for nyansatte og øvrige ansatte i det kommunale barnevernet. Deltakerne i studien besto av ansatte i det kommunale barnevernet (N = 228), hvor 71.7 % av respondentene hadde lederansvar. De ble invitert til å fylle ut et elektronisk spørreskjema. Resultatene av studien viste at det til en viss grad var etablert veiledning i den kommunale barneverntjenesten, men veiledningen som tilbys er av varierende karakter. Det kan imidlertid stilles spørsmåltegn ved kvaliteten på den faglige veiledningen som ble gitt i tjenestene, da det var stor variasjon i veiledernes formelle kompetanse. Videre fant vi at ikke alle nyansatte hadde tilgang til systematisk faglig veiledning på det tidspunktet vi gjennomførte undersøkelsen. Dette hang sammen med ressurstilfang og tilgjengelig kompetanse. Et annet funn i denne studien var at om lag en fjerdedel av de ansatte i den kommunale barneverntjenesten ofte vurderte å slutte i jobben sin, og at det veiledningstilbudet som finnes i tjenestene i dag ikke synes å ha noen effekt på ansattes ønske om å slutte. Dette er funn som bør undersøkes nærmere.There are extensive requirements to employees in child welfare services, and workers within these services have to deal with many professional, ethical and juridical challenges. The child welfare services have difficulties when it comes to recruiting and retaining qualified personnel in countries across the world. The child welfare services have high attrition rates, which also may have consequences for the quality of the services offered. Several disadvantages associated with being a child welfare worker have been studied extensively. Supervision has been suggested as a solution to reduce high turnover rates and to contribute to the professional development of new employees. Norwegian authorities have initiated implementation of supervision for new employees in the child welfare services, and the aims are to reduce dropout and to contribute to the professional development of new employees. This project aimed to examine the status quo in terms of supervision within the child welfare services. The participants consisted of employees in the municipal child welfare (N = 228), where 71.7% of respondents had managerial responsibility. They were invited to fill out an online questionnaire. Results of the study showed that supervision was established only to a certain extent, and the content of the supervision was of varying character. There was considerable variation in the supervisors' formal qualifications. Furthermore, several new employees did not have access to systematic professional supervision at the time we conducted the survey. This was related to a lack of resources and available expertise. Another important finding in this study was that about a quarter of the employees in the municipal child welfare service often considered quitting their 4 jobs, and that supervision provided within the services today did not seem to have any effect on employees' intention to quit. These findings should be investigated further

Parents with a mental illness and their sense of parenting competence

Objective - Research provides evidence that parental mental illness affects child development through parenting behaviour. This study investigates how parents with a mental illness report on their parenting sense of competence. Method - A sample of 141 parents receiving treatment at a clinic for mental health and substance use disorders participated. The Parenting Sense of Competence scale (PSOC) was used to assess participants’ parenting sense of competence. Information about diagnoses, child age and participation in a preventive family intervention called Child Talks was also collected. PSOC scores from our sample was compared to normative samples. Results - Parents with a mental illness reported having equal or higher PSOC scores compared to the normative samples. Neither children’s age, comorbidity nor parents’ diagnosis affected PSOC scores. PSOC satisfaction score was a significant predictor for participation in Child Talks, where lower scores were related to a small increase in participation rate. Discussion - The results indicate that parents with a mental illness do not view or report feeling less competent in the parenting role than the general population. We discuss the validity of the results and if there are factors that may influence parents’ reports such as stigma, fear of losing custody and impaired self-awareness

SIBS Søskenprosjektet

Denne artikkelen oppsummerer kunnskapen om effekten av søskenintervensjonen SIBS til barn med kroniske helsetilstander. Intervensjonen baserer seg på familiesystemisk teori med elementer fra resiliensteori, familiekommunikasjon, forståelse av sykdom og helsekunnskap samt kognitiv atferdsterapi. Intervensjonen er et manualbasert gruppetiltak der søsken og en forelder deltar over fem økter. Tre av de fem øktene er separate barne- og foreldregrupper. Det overordnede målet er å styrke kvaliteten på kommunikasjonen mellom foreldre og barn for slik å redusere risiko for utvikling av psykiske plager hos søsken som pårørende. Tiltaket tilbys av Frambu kompetansesenter for sjeldne diagnoser som gir opplæring i tiltaket og utdanner gruppeledere. Det eies av Frambu og Universitetet i Oslo

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

BACKGROUND: Mental 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. METHODS: The 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. RESULTS: The 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. CONCLUSION: The 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

Identification of Children of Mentally Ill Patients and Provision of Support According to the Norwegian Health Legislation: A 11-Year Review

Background: According to amended legislation implemented in Norway in 2010, personnel in healthcare services for adults are obligated to identify patients’ minor children and to assess the family situation. Health personnel is also obligated to contribute to adequate support to families affected by parental mental illness or substance use disorders. The intention behind the amendment was to support and protect children of mentally ill parents, as they are at risk of developing problems of their own. The aim of the present study was to evaluate health personnel’s practice during the years 2010-2020, more specifically; (a) to what extent children of patients with mental illness and substance use disorders are registered in patient records, and (b) to what extent activities relating to the assessment and support of patients’ minor children are documented in patient records. Method: The participants in the study are patients admitted to Division for Mental Health and Substance Use at the University Hospital of North Norway in the years 2010–2020. The data was drawn from patient records during October 2021. Results: The registration of patients’ minor children is considerably strengthened since the introduction of the new Norwegian Health Personnel Act in 2010, and estimates show that 56% of patients’ minor children are identified. However, only 31% of cases where patients have identified minor children this result in health personnel performing activities to support the children. Discussion: Based on the rising proportion of identified minor children throughout the 10-year period, it seems evident that the dissemination efforts have contributed to the development of some new skills among health personnel. However, compared with the national estimation that 35% of mentally ill and substance abusing patients have minor children, a large proportion of children remains unidentified. After identification, there seem to still be a long way to go before minor children are systematically offered support. Different solutions to strengthen the implementation of new skills in clinical practice, to ensure the identification of minor children and provision of necessary support for them is discussed